HomeMy WebLinkAboutR2023-0470 - Permit ApplicationRECEIVID BY
Print Form CRY of Newport Beach COMMUNITY
DEVELOPMENT
C061WIUNITY DEVELOPMENT DEPARTMENT MAY 312023
BUILDING DIVISION
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100 Civic Center Drive P.O. Box 17681 Newport Beach, CA92658-8915 CI YOF
�.� www.newportbeachca.gov 1 (949) 644-3200 116WIRTBEACH
Application for RepoIrt of Residential Building ReC®rds
Application Fee. _ $202.00
(For AIIResidential Buildings) Notice:
Reinspecdion Fee $134.00 Applications with insufficient fee
or incomplete will be returned payment
Please type or print and complete all information
#of Units: F Address: y
l 7777.r�l��(]r- City: Newport Beach State: �ilip:
Property Owner: ,
Owner Address: T�S - - Zip Code: qa 6a
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State: F - e: _. .
Zip Coder-i -
�- Home Phone: �0a-qD�-�p06
Owner's Authorized Agent: y\� 1 [" O o
I I C(a2h e- 14e-s�vv)�tt.\ Work Phone: G`F9 --7S
Agent Address: �qo� ZY _ d S
V l y: Cp-�t'izW Q / City: �-r 7
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F /2j Agent Email Address:
State: F--- Zip Code: 0G�amp-S
Escrow Company: Cyr-iDW
n%S ._ lhG Escrow #: �_--_._�--
Escrow Address: (_n f �1✓(J - _ .. ... -
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State: ZIP Code: r L� /, -- --
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Escrow Phone:
Email Report to:
For Inspection call (Name): Ii�J �^p 0. Gk �.iQ.- ��dtJChPi/-0�S �pryl
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 orZoning
violations are discovered I will be responsible to correct said violations.
Owner/Agent's signature to authorize inspection:
OR
Own /Agent'ssi nature to decline
Date:
615-22 Account # 01050504-521040 ................. Make checks payable to: CITY OF NEWPORT Bi:AcH
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