HomeMy WebLinkAboutR2023-0244 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
RECEIVED BY
COMMUNITY
DEVELOPMENT
BUILDING DIVISION MAR 2 7 2023
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
`bZHy www.newportbeachca.gov1(949)644-3200 CITY OF
NEWPORT BEACH
Annliration 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: F7 Address: i- 01 �C kot V,ei4 City: Newport Beach State: ICA]Zip:
Property Owner: �q j ✓�[ VI row. 5 t-s Zip Code:
Owner Address: Q '��5ei Alp �' �—tomy City: �yrlgof� per, L� '1
State: L 7 Zip Code: H] Home Phone: 7105691 d-
Owner's Authorized Agent: PPAI K PrN - Work Phone:
Agent Address: 2 0r r r #,2 City: kewtord- t3Po5C�
State: C Zip Code: 5
6 Agent Email Address: Irt'1
i , trips f �� r�aln . O
Escrow Company: 1"dm 6CYOW Escrow #: O S S 7 j'Q - W
Escrow Address: 12C )G N {W i pr � Ift r.- P"'vr iw
State: C Zip Code: �' �- (7
Email Report to:
City: rw 64'Recl
Escrow Phone:
1f0wA)69et—?q3q I
I 11Lv 4AI -F..s.o-1A1M -OCr'7c-)Wv ( of i &4t,141e. PrN S�C�i'P(i1 WILlN •�Q
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:
Owner/Agent's signatureto decline
OR
Date:
Date: 3,yq/y3
Building pvisia \Forms\RBR 615-22
Account# 01050504-521040.................Make checks payable to: CITY OFNEWPURI BALM