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HomeMy WebLinkAboutR2020-0291 - Permit ApplicationPrint For City of Newport Beach p,FCEfygrj e COMMUNITY DEVELOPMENT DEPARTMENT COA4MUNIrv� BUILDING DIVISION M'vFl�opMCN7 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92Q0RR8pt5 RBRN p7©7 Zz010c� www.newportbeachca.gov 1 {949) 644-3200 8 Application for Report of Residential Building Recordgyor h` Application Fee: - $191.00 Notice: 7V�0RT B[PCN (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 p of Units: F—Address: w CIX n City: Newport Beach State: CA Zip:19 To PropertyOwner: �- 0 n ` LNn! u �� edd Zip Code: f Owner Address: . ,-,SJC F City. . ecq5UC State: FCA— Zip Code: WO Home Phone: Owner's Authorized Agent: Fjon w 1 Work Phone: Agent Address: art City: S State: i V l Zip Code:9107-5 �J" D Agent Email Address: Escrow Company: I U1 f10 0 Escrow(Ad�dress ILi I I' Y State: I ( M- Zip Code: Email Report to: For Inspection call (Name): 611E -A Pftw I7Escrow H: 0nW7-pi T __. City: L.I Escrow Phone: tI� 1� 610 e(CIXAV Direct Phone: CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW) �e , 8 Uri 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 DaeuSigned by: Owner/Agent's signature to decline inspection: �bt,yisuy, Date: 3/16/2020 B6E4D37BF2B94913 � are� �Iec� ��sh! u1e �n< t� da �sc��� J�s �saq��-'Idcti�es�rcu�(�,�,��