HomeMy WebLinkAboutR2023-0178 - Permit ApplicationRECENEDBY
Pr1nt,F6rm City of Newport Beach coMMUNIiY
DEVELOPMENT
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION MAR 0 3 2023
100 Civic Center Drive ( P.O. Box 1768 1 Newport Beach, CA92658-8915
A®R# �L20 z3 n 17 S www.newportbeachca.gov 1 (949) 644-3200 CITY
NEWPORT BEACH
Application for Report of Residential Building Records
Application Fee:- $202.00 Notice.,
.(For AIIResidentiai Buildings) Applications with Insufficient fee payment
Reinspection Fee $134.00 or incomplete will be returned
Please type or print and complete all information
# of Units: F 7Address: City: Newport Beach State: CA Zip:
_2-9.21�assia.._.�tree-t------------------ -- --92 6_0_____
Property
Owner Address:
State: CA -__ Zip Code: 92660
—� Zip Code: L
City:
Newport Beach -----------
Home Phone: 949_636 1 312
Owner's Authorized Agent: �----- � Work Phone: l
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Agent Address: City:
-501.-5-...Br-ch--str-eat---------Neiapo-r--t Beaeh--------
State: [®Ca s� J Zip Code: 9�0-1 Agent Email Address:
f4 a x peg o-lden-@max ne g o 1de- n- Gm
Escrow Company: Escrow #:
Escrow Address: l City: J
#-30-00--- -Newport Beao - -- _----
State: Ca Zip Code: Escrow Phone:
�: 92660
---� --- - _949 945-291q,<_..._ .J
Email Report to:
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For Inspection call (Name): Direct Phone: [ _ I
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
l authorize inspections and re -inspections of the property listed above. )understand that if Building or Zoning
violations are discovered l will be responsible to correct said violations.
Owner/Agent's signature to authorize inspection: Dater
Owner/Agent'ssignaturetodecline Dat :
Account # 01050504-521040 .................Make checks savable to: CITY OFNEWPOR BEACH
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