HomeMy WebLinkAboutR2020-0342 - Permit ApplicationCOMMUNITY
01-VE1.013NIEN1"
11 M�City of Newport Beach
APR 2 3 2020
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
B .v100 C neer Drive I P.O. Box 1768 1 Newport Beach, CA92656-8915011YOF
www.newportbeachca.gov j (949) 644-3200
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Application for Report of Residential Building Records
I Appliwtion.Fee: -$191:00 .Notice:
(For All Reion Fsidemee ialBuildings) Applications with insufficient fee payment
$129.00 or incomplete will be returned
Reinspect
Please type or Print and complete all information
# of Units: F Address: F' ( 't t, r'; t. 1 t _ City: Newport Beach State: CA Zip. c i�t,,�,.
Property Own�
er: r�tt.-LFl n .I l,,.l„.-.i _ trt Zip Code: fi"�'�
Owner Address:1 11
.. 600 (�� .IYG.. V.19-Cl—
City:
State: I" ZipCode t-1pf 1 ''' Home Phone:
Owner's Authorized Agent: i r11 1t.+1 (C .fA,.? �flbt' Work Phone:
Agent Address: �. 1"11 r"s 1.t'..fl`�'l�1".1�Htt city:.. 1, tftt iGJ"t O
State: Zip Code: `J Y�tivK�..1� `+r1
�.. Agent Email Address:
Escrow Company: 52.V'kli Escrow #:
Escrow Address -Zc�'. e 41-21, 1 j_.
_ City: 1 (ir
State:F-16Zip Code: T I � Escrow Phone: 4 �qq-."
Email Report to: ( 1C rxJIL, `J e.✓il liwvl-6 V-0-,D`C-0r11
For Inspection call (Name): „�.. Direct Phone:
rONg£NT TO INSPECT (FORM MUST BE SIGNED a DATED BELOW)
I authorize inspections and re-nspectionsof the property listed above. I understand that if Building orZoning
violations are discovered l will be responsible to correct said violations
Owner/Agent'slsignature to authorize inspection:. Date: F
OR
9 Owner/Agent's signature to decline inspection: f ( A @ Dates
Account # 01050504-521040._ .............. Make checks payable for CITY Of NEWPORT SE4C14
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