HomeMy WebLinkAboutR2022-0191 - Permit ApplicationRGOEIVED By
COMMUNITY
City of Newport Beach DEVELOPMENT
COMMUNITY DEVELOPMENT DEPARTMENT A
BUILDING DIVISION FR 9 1 41.!42
r� 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, GA92656-8915
RBR# �XI�Z I� I www.newportbeachaa.gov 1 (949) 644-3200 CITY OF
Application for Report of Residential Building Records y�ORT eEPC;
: 'kPPI5Eatib6 Feet: -$I (q Notice:; .
. (Foc'All.Ri'esideritial.Bui{drngs}' Appficatrans urith irtsul cienYf-eepayment:
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Property
Owner Address:
State: CA
21p Code:F&I
zp Code<. �1 ZC�S1
Home Phone: '2' �C)
Dwner`s Authorized Agent:
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all information
65S Work Phone:
# of Units: IV] Address: ,
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City; Newport Beach State:
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Property
Owner Address:
State: CA
21p Code:F&I
zp Code<. �1 ZC�S1
Home Phone: '2' �C)
Dwner`s Authorized Agent:
Laura 9
65S Work Phone:
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Agent Address:
City:
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State:
Zip Code:
Agent Email Address:
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Emall Report to:
For Inspection call (Name): Direct Phone:
CONSENT TO INSPECT (FDRM MUST BE SIGNED & DATED BELOWI
has th'orze inspections.and re=iiaspectionsafthe property fisted above. I under5tandthatrf Budding wZorifng.
vrolatinlas-are-discovered'I Wfl:berespnns hl'eto correctsaid viibWtions.
Owner/Agentssignatnre'toauthar�ie inspe�iare: INSPECTION ,Date4
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Owner/Agent'ssigaaivre•tn deaifnahi pecGian, �� Date:: ®•� J
Account # 010S0504-S21D40 .................Make checks payable to: CITY OF NEWPORT BEACH
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