HomeMy WebLinkAboutR2022-0317 - Permits (2)City of Newport Beach
CDMMUN[TY DEVELDPMENT DEPARTMENT
BUILDING DIVtSION
�1DO Civic Center Drive I P,O. Box 1768 Newport Beach, CA92658-6915
MR# www.newportheachca.gov (949) 644-a2DD
Application for Report of Residential Building *Records
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COMMUNITY
DEVELOPMENT
JUN 3 0 2022
CITY OF
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#of Units: � Address: 52,Q ACQC.iA YC�i qty; Newport Beach State: E p:�
Property
Owner Address;
Zip Code:_ 0% 24—
state: Zip Code: -1 �a4 Home Phone: 14qLtill21, 0 ,0
Owner's Authortmd Agent 1 i� . L� 174 SWork Phone. CRa (4 tp (v 4; ( CC 1
Agent Address: /cv A- I j ddr City: N . �+_ "V
State: Zip Code: Agent Email Address: Q VC.
11 Val 110% 164— 17 NOW
Email Report to:
For Inspection call (Name); Direct Phone;
CONSENT TO INSPECT (FDRM MUST BE SIGNED & DATED BELOW)
ran— hi ize lnmpectbns.andre-ii S;pectiansafthe property hs-ted above. I or Zoning.
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INSPECTION f
OwrrerlAgenta'ssdgnature•toauthorizeirtspe�io� nE,1 IAIGIi•
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Owner/Agent'ssigrcature•ta decfieeinspecGinm: Date::
Account # G1Q505D4-521D40 ................. Make checks payable ta: CT Y OF NEWPORT BEACH