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HomeMy WebLinkAboutR2023-0315 - Permit ApplicationPrint Form City of Newport Beach RECEIVED BY COMMUNITY COMMUNITY DEVELOPMENT DEPARTMENT DEVELOPMENT BUILDING DIVISION p 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA9265'SPtiR 9458 2023 - # (L2023 " ©-3� 5 www.newportbeachca.gov 1 (949) 644-3200 CITY OF Application for Report of Residential Building Records PORT BEACH Application Fee: - $202.00 Notice: (For All Residential Buildings) Applications with insufficient fee payment Reinspection Fee $134.00 or incomplete will be returned Please type or print and complete all information #ofUnits: Address: 5 ���/��E G2E�h' 1��� City: Newport Beach State: CA....Zip: T ,q&, E lit%!//)A eft p lT' Property0wner: 'V f �I" Zip Code: / t Owner Address: 501%M>NE 626Z�& /Yz State: CA Zip Code: R��A--s Home Phone: Owner's Authorized Agent: �j22� �� Work Phone: _ -;2f Agent Address: [¢ F/q 621116 City: _ _ 02,&W,-2 State: I L— /7 Zip Code: F9 Z z5- Agent Email Address: Escrow Company: /yemlvrl�E Q//c �felnw Escrow #: -21 W — TS Escrow Address: &/0 City: State: I 57 Zip Code: T, q Escrow Phone: /q, n �2 V Q Email Report to: I f�/^��'p,//inC 5ejleCy661Qi.�_ For Inspection call (Name): � 6 12,V /� 6 ! Direct Phone: CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW) I authorize inspections and re -inspections of the property listed above. I understandthat if Building or Zoning violations are discovered I will be responsible to correct said violations. Owner/Agent's signature to authorize inspection: Date: OR Owner/Agent's signature to decline ���i� � f� Date: 11%S) 2� Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH Buildin�Division\Forms\RBR_515-22