HomeMy WebLinkAboutR2020-0846 - Permit ApplicationDocuSign Envelope ID: FCAEEA2A-3051-4616-8879-6D338338COA3
I ':. � City of Newport Beach'
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive l P.O. Box 1768 l Newport Beach, CA 92658-891
www.newportb�e r WgWjo(949) 6443200, ,
Application for Repod o#f#tesldentiWl Building Records
4adiicationFee: $ 194.00
For. pol:fresid4ential Buiidin Q�a���U
- - �) • - Apphcations.wdii msufiicienf fee payment' :
ieinspection Fee $124.00 - or incomplete will be returned'
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of Units: a Address;
roperty
wner Address:
:ate: L� Zip Code:
Ywner's Authorized Agent:
.gent Address:
tate:
scowCompany:
iscrow Address:
Yate: i
-mail Report to: /
Please type or print aifidMMO'Ae all information
city: Newport Beach State: CA Zip:
/ Zip Code:
City:
GHome Phone:
Work Phone:
City:
Agent Email Address:
:or Inspection call (Flame): Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNET) & DATED BELOW
lauthorizeinspecticins.andre=inspect'ionsofithe,p:roperb/listed;abov,Jundefstar at''ifBuildingar•'Zonng+
violations erre d lsccVered i wi(i be responsible to correct said violations
Owner/Agent's signature to authorize Inspection: Date;
/ OR.
Owner/Agent's signature to decline inspection:
��ss,aw, e. �i� tYf �. Ln.Wtl^� 1i'uSR.� 9/29/2020.
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Account # 010SC504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
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