HomeMy WebLinkAboutR2023-0314 - Permit ApplicationRECEIVED BY
Print Form City of Newport Beach COMMUNITY
COMMUNITY DEVELOPMENT DEPARTMENT DEVELOPMENT
BUILDING DIVISION APR �8 2023
100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA92658-89
agR# (LIQZ3 -C)3i'j www.newportbeachca.gov (949)644-3200 CITY OF
NEWPORT BEACH
Application for Report of Residential Building Records
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
# of Units: F Address: a,10 r- YYeh -_ /� ,0dWX)E City: Newport Beach State: CA Zip: C/'el1
Property Owner: o9,9T7-5-&AC—,A TAgS7— Zip Code:_
Owner Address: 5 - Y/14*7- 3,MMV,=- City:
State: CA Zip Code: Home Phone:
Owner's Authorized Agent: Gf yR.G6A- Work Phone: I / y9- za4
Agent Address: I 3-Wz City: I �,�.y9 ¢5l- /WC
State:::_® Zip Code: �6aS Agent Email Address: Sl/L 6i//glZ. (20/I7
Escrow Company: 1AE60&) ss"-na) Escrow #:I eg5'JT—%j;�/ ` 60
Escrow Address: 1,10o Ab-966 rlz5e•WllrO City: I 10FW)'bA7
State: ICW Zip Code: 4� Escrow Phone:
Email Report to: I C5(9,�
For Inspection call (Name): Direct Phone: �-
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
I authorize inspections and re -inspections of the property listed above. I understand that if Building or Zoning
violations are discovered I will be responsible to correct said violations.
Owner/Agent's signature to authorize inspection:
190
Owner/Agent's signature to decline
Date:
Date:
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
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