HomeMy WebLinkAboutR2020-0526 - Permit Application13=3ign Envelope ID: 5D542C5E-7C78-4BEE-A8C7-1 B322FEA7499
pr1t Form City of NewportBeach
COMMUNITY DEVELOPMENT DEPARTMENT 1'di
r' �d
BUILDING DIVISION COMML
100 Civic Center Drive ( P.O. Box 1768 1 Newport Beach, CA92658,l gift
RBRii ���(:� ,✓ �)jZ www.newportbeachca.gov (.949) 644-3200
JUN 3
MIJiJ MCIcrescr ivr rvcpsvri ul rteallucrt clue DUHU Bir, MULUllub
rel..fy OF
Application' Fee. - $191.00 Notice:
(For All Residential Buildings)Applications with insuf€P�{ i . egfjment
Reinspection Fee $129.00 , or incomplete will be returned
Please type or print and complete all information
ti of Units: Address: * 'i City: Newport Beach I State CA ;Zip:
r- S _ f'
Property
Owner Address:
State CA Zip Code: ] j
Owner's Authorized Agent: Work Phone
��rCc� i rye
Agent Address s`. . - ---- 1 City: f 1 ..
State: Zip Code: >
.Agent Email Address:
Escrow Company: ` ....IC�^�--- _c,, +_ Escrow #: I t...
Escrow Address: 00)(ftz
1yp �' City: i i F
State: Zip Code: WUo Escrow Phone:
Email Report to: j
For Inspection call (Name): j 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 correctsaid violations.
owner/Agent's signature to authorize inspection: Date: -
OR
bo.osqaev oo<sm.nnv> 628/2020 Y
Owner/Agent's sinat re to decline inspection:
Abd -1]. &axaUeN., liush,l, I l=ai(unmt, K.
� E , Fseczns,n,. E�,os��s.A� 6 28 2020
Account if 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
fluildinK fllvisian\forms\RflP_9.ia-tE