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HomeMy WebLinkAboutR2023-0696 - Permit ApplicationCity of Newport Beach COMMUNITY DEVELOPMENT DEPARTMENT A-WauflmT� BUILDING DIVISION MLV'S@1Rp)ggp 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658 0015 RBR# 9202-5 e)(A 6 www.newportbeachca.gov 1 (949) 644-3200 Gr JJ 2 9 2023 Application for Report of Residential Building Reco%o OF °6�RT 8E a —� 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: FF1 Address: 530c1 S&Tc 6y City: Newport Beach_ State: CA Zip: 63 Property Owner. -q JWakZ4 U,Y-A L Zip Code: Owner Address: C iW JS Ok V-10-4e City: State: Zip Code: Home Phone: Owner's Authorized Agent: Agent Address: Work Phone: City: State: Zip Code: Agent Email Address: Escrow Company: KkUm Cscx „_ __ - Escrow #: Qs S� 3 1 �W Escrow Address: I ��- (32 (* � 7, a) City: State: © Zip Code: FT 6 Escrow Phone: Li - I V q'L - 3937-1 Email Report to: tbmes(-fow . c r--, I 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: Date: OR Owner/Agent'ssignatureto decline Date: Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH Bind,, Dw,s.on\F.,m,\RBR_B-1B-ZZ