HomeMy WebLinkAboutR2022-0289 - Permit ApplicationICOCEIVEp 6
Print Form ' City of Newport Beach COMMUNITY),
COMMUNITY DEVELOPMENT DEPARTMENT DEVELOPMENT
BUILDING DIVISION I� InI
��77'' 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658 051 0 2022
_ �L RBR#2 www.newportbeachca.gov 1 (949) 644-3200
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Application Fee:-$198.00
(For All Residential Buildings)
Reinspection Fee $131.00
Notice:
Applications with insufficient fee payment
or incomplete will be returned
Please tvoe or print and complete all information
# of Units: Address:heJ City: Newport Beach State: [CA Zip:
Property0wner: _
Lei=�,nr r�rct rn; l y 7rUs-�, K)n�j5/�y �v�l� JJ3 —),,Zip ,lCode:st ��77;
Owner Address: city: 1. LiQI
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State: �_. Zip Code: � � Home Phone: 7 Y-9)
Owner's Authorized Agent:/ Work Phone: ��yq S
Agent Address: 31 %) PorkLII I V� City: Z-4 �] Y
State: FLA Zip Code: 2(�77 Agent Email Address:
Escrow Company: I I U ref V i 4z,..1�,SLr '
Escrow Address: 12,50 r ccavv 1 n o ee'ed
State: Fcf{_Zlp Code: I C1 2.790 :.
City: T I,Y,
Escrow Phone: 04 -7&q_ U-740
EmailReportto: AInITA15'0"sliAKI"A(2CAfnVC-S»C.Q'i►°t,y'IjAKY UREL00cGsOwfUs9.wyn
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For Inspection call (Name): AMY LFcli NFp— Direct Phone:
CONSENT T6 INSPECT (FORM MUST BE SIGNED & DATED BELOW)
I authorize inspections and re -inspections ofthe property listed above. I understand that if Building or Zoning
violations are discovered l will be responsible to correct said violations.
Owner/Agent's signature to authorize inspection: Gam, Date: /� 2�
OR
Owner/Agent's signature to decline inspection:
Date:
Ruildin�GWsian\rarms\RBR_7-1-21
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH