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HomeMy WebLinkAboutR2023-0799 - Permit ApplicationMI. ae: RECEIVED BY FCity of Newport Beach COMMUNITY `r COMMUNITY DEVELOPMENT DEPARTMENT DEVELOPMENT BUILDING DIVISION � 1 5 2023 (n� 100 Clvic Center Drive I P.O. Box 1768 i Newport Beach, CA92658-891 IRtI 1` W 1-3 - 01ct `1 www.newportbeachca.gov i (90) 6443200 CITY OF Application for Report of Residential Building RecordsEwPORT BEACH Application Fee: - $202.00 Notice: (For All Residential Buildings) _ Reinspection Fee $134.00 Incomplete with insufficient me fee payment te will breturned Please type or Prirrt and complete all information YofUnits: El Address: aL��(P2" City: Newport Beach State: Zip: q Property Owner Address: State: Zip Code: I I7 Zip Code: City: i Home Phone: I � I q , 715 — 6,(J- Ce Owner's Authorized Agent; ( �_ y�ri ,/, � Work Phone: 1 � 4& 1 Agent Address: I )��'( �"'!�\-1�. city: i- ---- Stater Zip Code: F�—��(O Agent Email Address: Escrow Company: )a�t�� l�U EscrowM: Escrow Address: l a / C6I � Ave City. �k" n Stater--t Zip Code: �� T �� Escrow Phone: Email Report to: I l i-sN r t �.t�Lra/yJ n v,nn,��rC��.©n•Z For Inspection call (Name): ( Direct Phone: I I CONSENT TO INSPECT iFORM 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 1 will be responsible to correct said violations. Owner/Agent's signature to authorize inspection: Date: OR Owner/Agent's signaturetodedine Date- J( Z02- 3 Account ri 02050504.521040 .................Make checks payable to: CITPOF NEWPORT BEACH dlklrLd+Yc�omu� 615-II