HomeMy WebLinkAboutR2022-0189 - Permit Application,�CeIVED Bi,
COMMUNITY
City of Newport Beach DEVELOPMENT
COMMUNITY DEVELOPMENT DEPARTMENT APR ®$ 2022
BUILDING DIVISION
01 R� 100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA92658-8915
RBR# V www.newportbeachca.gov (949) 644-3200 CITY OF
Application Fee: - $198.00
(For All Residential Buildings)
Reinspection Fee $131.00
Tor Keport OT Residential
Recorcf5gi`ORT n"
Notice:
Applications with insufficient fee payment
or incomplete will be returned
Please type Or print and complete all information
#of Units Address _ i CYiS�oL& J City: NewportBeachj State: CA IZip: P h� _
Property Owner: L� — — Zip Code:��
Owner Address: 1 vic"L C1'�S{Cc-` 1 City:
State: CA Zip Code: T24.J`_ Home Phone:
Owner's Authorized Agent: ` �( work Phone:
Agent Address: L}n� S rx)YG'ISnJ City: Y✓i>--------- ----- --.1
State: F Zip Code: -�Z�12 - Agent Email Address:
Escrow Company: -----w- ----- - Escrow#:-,--- , =L-0 ------------ ---- -
Escrow Address: -I�y�'y-�y-,`fir, _S S/� City:
y v".ir`2 — ---- ----- ----------------
State: _ ---- �� ____-_ Zip Code:--�2�_- Escrow Phone:
Email Report to: --,,rnw Gam_ - l'�C;C ' 'Y7'��' eSCY _wL�h�
For Inspection call (Name): _ Direct Phone jlcl — (�,5> _
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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 I will be responsible to correct said violations.
Owner/Agent's signature to authorize inspection: xl Date:
R
Owner/Agent's signature to decline inspection: Date:��
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
Build in,,Division\Forms\RBR 7-1-21