HomeMy WebLinkAboutR2022-0101 - Permit Application��rEIVED Hy,
City of Newport Beach COMMUNITY
COMMUNITY DEVELOPMENT DEPARTMENT UEVELOpMEN1
n BUILDING DIVISION p 2.8 2022
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92656-8
RBR# GG ` www.newportbeachaa.gov 1 (949) 644-32D0
CITY OF
Application for Report of Residential Building Recordsn, Pct'
Ano6iation Feet: -$I I�Td • Notice:;
(F6r.'p11�R;esideritiai,Build[ngs)' kppiicatf6nswith.i'nsuf.Fcientfeepayinent:
Reinspe�ionF.ee:$T29:DDr ,. orinrompletewill:6e;iietumedl , •
Please type or print and complete all information
It of Units: M Address:
Owner Address: I H30I
State: Zip Code:
City; Newport Beach State: CA Zip: 923
Trp Code-
cty: IN ort
Home Phone:
Owner's Authorized Agent:
rr''• Pht l (J A r'� _ Work Phone: Q
Agent Address: � Z`"t n S• Svui k -E Gty: ew &- --
State: Zip Code: �l�U r¢?j Agent Email Address: �a f� uhf �$ • , �jy�
Escrow Company: ( Escrow
Escrow Address: NetJ aw+Qr City: J
State: L--�-�JJZip Code: StAI kgs Escrow Phone:RW
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Email Report to: p�� ei5 cfv yj. ceY i
For Inspection call (Name): Direct Phone:
CONSENT TO INSPECT' (FORM MUST BE SIGNED & DATED BELOW)
haathi dme iricpectrons.andre=irispectiorisaf•'the property listed above. I understarid-thatrf Bua7dingorZoning,
vro.lationsarediscovered'I wilPbe:responsibl'e.to correctsa d vibietions.
Dwner/Agent'ssignatureto-authnrrtie-inspectfan:
Owner/Agents:sig:mi ture•todecirne.impectibm:
Account # 01050504-521040 .................Make checks payable tar CITY OF NEWPORT BEACH
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