HomeMy WebLinkAboutR2022-0195 - Permit Application,GEIVED ay
City of Newport Beach coMMUN\Tv
DEVELOPMENT
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION o 112022
7 p (� 100 Civic Center Drive I P.O. Box 176E I Newport Beach, CA 9265E-B915
RBRitma- O 11./ www.newpcirtbsachca.gov 1 (949) 644-32DD cl-ry OF
Application for Report of Residential Building Records AEyypoRl BEA
Avo6Latbbc Feet:-$r iq . Notice:;
(Foc'ti1L4iesideritiahByi{d gs)' Applicatiunsu!ith.iiesnffcient'feepayinent:
ReinspecYion• Fee:$•Y29:ODor{•nrompiete will:lie;neLvrned:
Please type or print and complete all information
# of Units: ID Address:
City: Newport Beach State: [CA]Zip:
Property owner.haviA L r � z- v U+"
Zip Code:. I LOT
Owner Address:
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Zip Code:
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Home Phone:
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Owner's Authorized Agent: l I Work Phone:
Agent Address:% City: -�-
State; Zip code: Agent Email Address: a(' k� � C y-�• w�1 \l.e '�C r ��,,, ^
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Email Report to:
For Inspection call (Name): Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
FasRFror2e inspectioru.and.re=i:�spection'softhe properly f%sted above. I ruiderstaridthaLif i5phdingvrfDning.
violatinrasarediscvvereda uvilhbe:respritasihl'eto correctsa�d vibiativns. •
Ovrner/Agentf5s{gngtore'to autha.INSPEC°.i ION
DEC, NED
Owner/AgeaC'ssigraatore-7n deciioe.inspecGTnm: Date.
Account # 01050504-521040 .................Make checks poyaMe ta: CITY OF NEWPORT BEACH
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