HomeMy WebLinkAboutR2022-0154 - Permit Application¢sCCIVUL) gy
COMMUNITY
DEVELOPMENT
City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, GA92656-8915
RBR# www.newportbaachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
MAR 21 2022
CITY OF
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(For AILV%siderrtial.Bui{dings)' ppplii-kibnswith.ihsufficient•fee payinent
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#ofUnits: M Address: Q,fty; Newport Beach State: CA Tip:
Property Owner. - K O A VV Tip Code:.®
Owner Address; U kC � Q '[ city: I N Cr �!1
State: CA Zip Code:• l Off" I.l (C� Home Phone: "l �/'� LU Zb
Owner's Authorized Agent:OA�q VA Work Phone: 10 q . q
Agent Address., 1 1574 t✓ i-; ity;
State: I /\,{/,�. I Tip Code: [A� Agent Email Address: CA hCl/�ji/i%l� �t^/n� �Y► r
Email Report to:
For Inspection call (Name): Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
PaLth'o'rze it spectiorts.andre=iiaspechionsafthe property listed above. I un'derstarid-that f B'uhrlingorZoning.
vialatiolisare.d{scovered'I arill�lie:responsihl'eto corre s is ' n
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Own'er/Ag�ntssignature'to•autho�zernspediom: DECLINED I Date.. —I
Owner/AgemY'ssigmatur-evto deciioe.inspectiom:
OR �
aWIAnLGIrhlenlGemu111en 9-061B
Account # 01050504-521040 .................Make checks payable to; CITY OF NEWPORT BEACH