HomeMy WebLinkAboutR2022-0181 - Permit ApplicationGity of Newport Beach
COMMUNITY DEVELOPMENT DEPAPTMENT
BUILDING DNISION
1Do Civic Center Drive I P.O. Box 1768 Newport Beach, CA92658-8915
RSR# www,newpcirtheachca.govl(949)644-3200
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COMMUNITY
DEVELOPMENT
APR 04 2022
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Application for Report OT Resloential isuuoing icecoras
Application Fee::-$( (q I Noticm; .
For.A114i'esideritial.Byi{divgs)' Appii�atiianswith.insuF;FcienYfeepayinent:
ke'rnspe�ion Fe ori'ncomplete will:lie;iietvrned: ,
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Property Owned y ( '(Q e .-1 SGY Zip code:.
owner Addre=3'VO C Q cty; EaW K,'� e as, V 1
state: I� zip Code: Home Phone: 12-0 10 2- d
Owner's Authorized Agent: �(tne• ACCaII �) it I) e?I rl?-�Work Phone: qqa V (0 l-1 -I k -5
Agent Address:La
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State; • I zip Code: Agent Email Address: e • 1 Qr ��� !✓W) C
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Email Report to:
For inspection call (Name): Direct Phone;
CONSENT TO INSPECT (FORM MUST SE SIGNED & DATED BELOW)
Fautho'rze inspections.andre=iraspection'saf•'the property fisted above. I anderstarid-thatrf Buiidingaorfoning.
vialatin isarediscovered:I w ill be: respnms bl'e.to correctsai'd vitiations.
Owner/Agent''ssigoatare'toauthonFze•Enspection: Qate..�--I
R ED
Owner/AgeoL'ssigrrature•todeciieeinspectina: Date:LTt
Account # D1D50504-521040 .................Make checks payable to: C17Y OF NEWPORT REACH
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Please type
or print and complete all information
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#ofUnitr:I 1 I Address:�C—Qnv�
!1t A }A� I Clty; Newport Beach State:
CA TP: P�Q3
Property Owned y ( '(Q e .-1 SGY Zip code:.
owner Addre=3'VO C Q cty; EaW K,'� e as, V 1
state: I� zip Code: Home Phone: 12-0 10 2- d
Owner's Authorized Agent: �(tne• ACCaII �) it I) e?I rl?-�Work Phone: qqa V (0 l-1 -I k -5
Agent Address:La
(� �! `' C ty: 1 �V 1
State; • I zip Code: Agent Email Address: e • 1 Qr ��� !✓W) C
.. ���' ... - , _ - + �I ' • Giro .�! ���
Email Report to:
For inspection call (Name): Direct Phone;
CONSENT TO INSPECT (FORM MUST SE SIGNED & DATED BELOW)
Fautho'rze inspections.andre=iraspection'saf•'the property fisted above. I anderstarid-thatrf Buiidingaorfoning.
vialatin isarediscovered:I w ill be: respnms bl'e.to correctsai'd vitiations.
Owner/Agent''ssigoatare'toauthonFze•Enspection: Qate..�--I
R ED
Owner/AgeoL'ssigrrature•todeciieeinspectina: Date:LTt
Account # D1D50504-521040 .................Make checks payable to: C17Y OF NEWPORT REACH
ewmn�m.m.n\F•�s\mow ��