HomeMy WebLinkAboutR2020-0345 - Permit ApplicationPrint Form
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City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
Application Feer- $191.00 Notice:
(For All Residential Buildings) Applications with insufficient fee payment
Reinspection Fee $129.00 or incomplete will be returned
Please type or print and complete all information
# of Units: �'. Address: 3 , C�WI l0 Y' j Y • City: Newport Beach '.. State: CA Zip: '..
Prooerty0wner: 5tNe-rt- 5U.r',.YCG12.iL!
Zip Code: F
Owner Address: l �� GLIM �Q Yi �� V Y. City: lL�t�pcY� ctC�j
State: CA Zip Code: �-Ce }t,J Home Phone: L+1) PLO'(— 71:137 L.
Owner's Authorized Agent:
�on L c L QrU Y work Ph�onVe: q4y p
Agent Address: e� City:�
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State: C� Zip Code: R�GO3 Agent Email Address: x$'11 z(/�C�hd Gc?Ntr9V85,'.COIy/
Escrow Company: Escrow #:
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Escrow Address: L �i 5ovto Co(t� f- Dr:5tle4rt-fV City: �G�ytj I� Lo5Ci
State: C Zip Code: ol iib? (� Escrow Phone: (714 t.) S7' % 3�
Email Report to: J 50O 1. Z i1 C Ga ro l`.r C- a YN.O t/ e 5 T C C%m
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 l will be responsible to correct said violations.
Owner/Agent's signature to authorize inspection: Date;
Owner/Agent's signature to decline inspection:
BulIding_DIVISIOn\Forms\flBfl 9-18-18
OR
Date:
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH