HomeMy WebLinkAboutR2023-0462 - Permit ApplicationRECEIVED BY
COMMUNITY
City of Newport Beach DEVELOPMENT
COMMUNITY DEVELOPMENT DEPARTMENT MAY 2 5 2023
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA92658-8915 CITY OF
R9RqZ www.newportbeachca.gov (949)644-3200 NEWPORT BEACH
Application for Renort of RPciriontiol
Application Fee: - $202.00 Notice:
(ForAll spectiin Fee Residential Buildings) Applications with insufficient fee a Reinspection Fee $134.00 payment
or incomplete will be returned
#of Units: 17 Address:
Property
Please type or print and complete all information
City: Newport Beach State:
CA Zip: Z�
Zip Code:
City:
Home Phone:
Owner's Authorized Agent: Work Phone:
Agent Address:
City:
State: I Zip Code:
Agent Email Address:
Escrow Company: $ /�//i Z ,C
Escrow #: Js�
Escrow Address: 1 �.� ^ y City: I ��
State: p Code: t-� -Tku 1
i--�¢--�—J Escrow Phone: —� L, 3�2
Email Report to: pn nA.L.Annrn..—..A J
Owner Address:
0
State: CA I i--+-��-`—{�
Zip Code:
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 signature to
Date:
Date: "Z-7c)7
Building Division\Forms\RBR 6-15-22 --------•--_„-„............rvrunc uiecxs payome ro: CITY OF NEWPORT BEACH