HomeMy WebLinkAboutR2020-0832 - Permit ApplicationPrint Form City of Newport Reade ReceavFoe
COMMUNITY DEVELOPMENT DEPARTMENT c0M >
BUILDING DIVISION �cpM(/N/Ty
�7 100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA92658-642
RBR#RZOZO-0932 www.newportbeachca.gov 1 (949) 644-3200
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Application Fee: - $49-1:06 (�I�� li, Notice: PORT
(For AIIResidential Buildings) Applications with insufficient fee payment
Reinspection Fee $129.00 or incomplete will be returned
Please type or print and complete all information
#of Units:rim
Address: `3�a(����0� City: Newport Beach State: CA Zip:
Property Owner:C..�CW1S50.,.yS�.�,(\\L�,� Zip Code: F
Owner Address: City:
State: CA Zip Code: Home Phone:
Owner's Authorized Agent: MCkv \C\Avl 1C, work Phone:
Agent Address: I City:
State: Zip Code: I Agent Email Address:
Escrow Company: I - vCPAU(Yl U—,�CTO C)
Escrow #: I
Escrow Address: ` � �e,vU �OY� CkroQ y N , AVk%b City: &)Zk(h
State: I E Zip Code: FaADLLD Es[crrowPhone:
Email Report to: 1(`,t��'V e2C�.�T��S_.Y (a,�,- axf-) -p —y 16CC�'�'�\�AQQ-&nC—Cmz- ax
For Inspection call (Name): Direct Phone: I
CONSENT TO INSPECT (FORM MUST BE SIGNED& DATED BELOW)
I authorize inspections and re -inspections ofthe 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: ' h Date: I C � r,)1150
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH