HomeMy WebLinkAboutR2022-0164 - Permit Application15 ctp") Cscruv-
City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION ooMMuNI�/M�\,v�l
jj�� 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-89 coELOPM
RBR# /i%' V I www.newportheachca.gov 1 (949) 644-3200 MAR 2 9 ZOZZ
AoDlication for Report of Residential Buildine Records
Avol{c3666 Feet: -Notice: . • h :•p,G� .
For.'AILRtesideritial.Bui{d(ngs)' ApplicatibnsuAth.insuFTi ment
ReirtspecYion•F.ee:$.523:00prihrnraplete willaie;rie'turned:
Please type or print and complete all information
#of Units: M Address: ✓✓VI oty: Newport Beach
State:
state: zip code:
F Agent Email Address:
Escrow Company: Escrow 0.
State: = Zip Cade: Escrow Phone;
Email Report to:
For Inspection call (Name): Direct Phone:
CONSENT TO INSPECT (FDRM MUST BE SIGNED & DATED BELOW)
hauthcra7e inspections•and re irsspection'saf•'the property ffsted above. I understrid a -that f B'uaidingorZoning.
violat{orksare.discovered.'I uvill lie:respbns bl'e.to correetsa�dviblati{ans.
Owner/Agent:ssigaatore•toauthoraieinspectian: INSPEC 1 ION Date4
Owner/Ageats:sigr,atur*Lt o deciine.inspectibm:
Account # 01050504-521040 .................Make checks payable to: CriY OF NEWPORT BEACH