HomeMy WebLinkAboutR2020-0950 - Permit Application_.,i rl(7 VCU r
Print Form City of Newport Reade coMMUNIT�)
COMMUNITY DEVELOPMENT DEPARTMENT '11'11EIOPMEN7
BUILDING DIVISION NOVQ gg 2020
�j 100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA92658-8 NOVA
2020
K—tzo — ocisb www.newportbeachca.gov (949)644-3200
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Application Fee: - $191.00 V
(For AIIResidential Buildings)
Reinspection Fee $129.00
Notice:
Applications with insufficient fee payment
or incomplete will be returned
Please type or print and complete all information
# of Units: Address: i2 -q ` `YpJ City: Newport Beach State: CA Zip:Min
Property Owner: ` cIl I ` r �V �u �rb(�c
Owner Address:
State: {CA Zip Code:
Owner's Authorized Agent:
Agent Address:
State:
Zip Code:
City:
City:
Agent Email Address:
Home Phone:
Zip Code:
Escrow Company: L- iLc \\ Escrow #:
Escrow Address: Y City:
State: c de: \ Escrow Phone:
Zip Co/���
Email Report to: IVCD('}' 1eS��rV tI \ CI}�•,�/C(f�, C�'�'l�
For Inspection call (Name): 4W 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 I will be responsible to correct said violations.
Owner/Agent's signature to authorize inspection:
Date:
OR
Owner/Agent's signature to decline inspection:�2e.
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH