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HomeMy WebLinkAboutR2023-0993 - Permit ApplicationCity of Newport Beach ii COMMUNITY DEVELOPMENT DEPARTMENT RECEIVED By COMMUNRY BUILDING DIVISION DEVELOPMENT 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-89.1;� RBR# ��Z� ' 04g3 www.newportbeachca.gov 1 (949) 644-3200 IV V 2 0 2023 Application for Report of Residential Building Records �o of I v"r�'�. rr r><n x� et{ , ➢ d" %par,rxss ha ' A�-',.-"cf� NOYIcef 4 �# ons with insufficient fee p1e �I z tTt tie` m a J xr7Tfolcmplete will be returned { Please type or print and complete all information # of Units: © Address: ()�I -`� city: Newport Beach State: FZip: ]r Property Owner Ac State: CCF Zip Code: City:�btftAA Home Phone: owner's Authorized Agent: Work Phone: Agent Address: F City: State: E777 Zip Code: Agent Email Address: Escrow Company: &L3-,A ft !EU"Vq Escrow #: 0 p i N Escrow Address: I1"W N I City: A -It,I State: I / A Zip Code: Il WO Escrow Phone: - R I - 6 UI Email Report to: I JW FV WW"^-fAC r4W -UVA 't* ll�f (f(QWI - LPVV" For Inspection call (Name): Direct Phone: CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW) i?e inspections and re -inspections of the prop nsare discovered l will be responsible to corre %gems signatureto authorize inspection: nt's signature to decline e. I understand that if Building or Zoning I.S�y.I 'Aifi�'r�"J .v i:�IR4 ttl4a. ti �bM}1.4 �t�5P, a A"c F f �. IiatP Account # 01050504-521040.................Make checks payable to: CITY OF NEWPORT BEACH Wilding_ olvlslonVormsMR 6-16-22