HomeMy WebLinkAboutR2022-0349 - PermitsCity of Newport Beach I
COMMUNITY DEVELOPMENT DEPARTMEN
BUILDING DIVISION
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Application for Report of Residential Buildin
Records
Application Pee: - $�4o jtjjS� Notice•
(For all Residential Buildings) Applicatio
Relnspectlon Fee $125.00
swith Insufficient fee payment
at income
will b
ete e returned
Please type "print and complete all itiformat
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# of Units FJ c Address: �i `T� f City: Newport Bea
h) State:.. CA Zip:
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PropertyOwner, 'j-,Fji)/+._� ��Lf
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Owner Address: i_jai �nAFL) city.4
State: CA i Zip Code. �Z.���V' Home Phone:
Owner's Authorized Agent: Work Phone:
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Agent Address: - D_City:
State:- t�--- _f Zip Code Agent Email Address:�-a._
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Escrow company: Escrow#:J
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Escrow Addressid-Y.l-__._s....L�i-._4..., 4.. Y._� City:.
State: Zip Code; Escrow Ph
ne:
Email Report to;
For Inspection call (Name);. i�' Dt
act Phone �V
CONSENT To INSPECT FORM MUST BE SIGNED & DATE6
BELOW)
I authorize inspections and re -inspections of the property listed above.I understan
that if Building orZoning
violationsare discovered I will be responsible to correct said violations.
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Owner/Agent's signatureto authorize inspection: } %-)
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Date:
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Owner/Agent's signature to decline inspection: )
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Date: F
Account 9 01050504 521040......._........Make checks payable to: CITY OF �EL+IPORTBEACH