HomeMy WebLinkAboutR2022-0165 - Permit ApplicationRBR#=Z-0105
City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT 00M1t;At;NI't'
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-891'
www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building
Please type or print and complete all information
#of Units. Address: a5`%J% 2_ _LOQ QS City: Newport Beach! State: CA Zip:
Property Owner:par;ck Code:Ut1��Qn . Zip CqG
Owner Address: 17CAMl)Oo �11T'. City: ►Ju.+for�....� ---..
State: CA _ Zip Code: �aGGo Home Phone: Nl�r77
Owner's Authorized Agent: N Ik Work Phone:
Agent Address: City:
State: � Zip Code: Agent Email Address:
Escrow Company: [$Crotsl Escrow#: OSSa(vo—"�LJ
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Escrow Address: 12op City:,cv ofk AGh _
State: ' Zip Code: - Escrow Phone:
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Email Report to: W
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for Inspection call (Name): Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
I authorize inspections and re -inspections of the property listed above. I understand that if Building or Zoning
violations are discovered [will be responsible to correct to
TION
Owner/Agent's signature to authorize inspection: DECLINED Date:
AOwner/Agent's signature to decline inspectionDater` ('
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