HomeMy WebLinkAboutR2023-0529 - Permit ApplicationPrint Form City of Newport Beach RECEit
COMMUNITY DEVELOPMENT DEPARTMENT DE�M �pD
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BUILDING DIVISION EtOPMENT
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8 0
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nazo23 -o`5ZCi www.newportbeachca.gov1(949)644-3200
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Application Fee: - $202.00 Notice:
(For AIIResidential Buildings) Applications with insufficient fee payment
Reinspection Fee $134.00 or incomplete will be returned
Please tVpe or print and Complete ail information
# of Units: Address: C �� /J lI Vt� City: Newport Beach State: CA Zip: 7d2.,6S'
Property Owner: ✓�v Ll Zip Code: I
Owner Address: zlY GArv/�i vVrAJ 6 City: rp—vx-�Jc-
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State: CA Zip Code: qR Home Phone:
Owner's Authorized Agent: ��1- L_r_
Agent Address: I z1ol a X14,ePAAJ(-A Pkw y -714-/ oo City:
State: T� Zip Code: / 1'b Agent Email Address:
Work Phone: 1 % 411- 3�-3 - g g 77
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Escrow Company: I W .-4 65 C/?,Q W ��Mes Escrow #: j -'> — / 3 7 3 b�Y
Escrow Address: 1-7101 14 R&ii((p ) I G "o City: P)t/pt� t°l\j zCFAcff
State: F 2r/� Zip Code: Escrow Phone: �r�� —Z 3 % /057
Email Report to: rE t (y FFt Gt C5T�6-S [,
For Inspection call (Name): I T 6 r L
Direct Phone: I q % "/ - 3/61113
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's signature to decline Date: 6
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
Bulldin�Division\Forms\RBR_6-15-22