HomeMy WebLinkAboutR2023-0749 - Permit ApplicationPrint Form
RECEIVED BY
City of Newport Beach COMMUNITY
COMMUNITY DEVELOPMENT DEPARTMENT DEVELOPMENT
BUILDING DIVISION G 14 2023
inn Civic Center Drive I P O Box 1768 1 Newport Beach, CA 92658-89T5
RBR# P,1U�-3 -�4 � www.newportbeachca.gov I (949) 644-3200
ADDlication for Report of Residential Building Records
CITY OF
NEWPORT BEACH
Application Fee:-$47"IlY Notice:
(For All Residential Buildings) Applications with insufficient fee payment
Reinspection Fee $ 115.00 or incomplete will be returned
Please type or print and complete all information
# of Units•. F— Address: `,I O` �� �� City: Newport Beach State: CA Zip: 9
Property Owner: KUL c� N M 9Li l T t t� N Zip Code: q Z� � 6
Owner Address: 1 �� PN LOH k D 1 City: IV 3
State: CA Zip Code: 2 (p o T) Home Phone:
Owner's Authorized Agent: ALyssA e3-Q �S Work Phone: 9gq_7(7_'71q-q
Agent Address: I q60 U�`Ed(Z�C� D,# Ty tOQi C�' NGl1 d� 1
State: FE�-I,,r�
— Zip Code: Agent Email Address: K t�s t Y/ Tu Q%���
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Escrow Company:
Escrow Address:
State: I
Email Report To:
For Inspection Call (Name):
Zip Code:
Escrow #
City:
Escrow Phone: F—
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 decline inspection
OR
Date:
Date: I 9 - I - ,� 6IZ3
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