HomeMy WebLinkAboutR2020-0837 - Permit ApplicationDocuSign Envelope ID: 7CD97DCC-5855-4F35 AAAO-79137OB7043B
l @ City of Newport Beach 1 iA
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
p 100 Civic Center Drive 1, RO, Box 17681 Newport Beach, CA92658-89
iRiDZCi20 —OB31 www.newportheachca.gov ( (949) 6444204
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Application for ReRbrt of Residential Building Records,
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Analkatran Fee $-1-94.00 Notaee
() xir ¢IIR�sidetrtial Buildlings) SEP 2A "RECD ApPlicatlolnsx Wirth jns'X derrt fee pa jmerit
Reinspection Few, 129X0 or incomplete diie retui ne'd*
bofUnits: E Address:
State: ElZip:j
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Zip Code:
'tate; ICA Zip todet
Dwner's Authorized Agent -
Agent
itate:
Scrouv'Company:, fir` ,i. ' r�`' ✓l Escrow #1 Z � 6 'w
Escrow Address:[L60— AMaif 607)Y
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State: Zip Code: w2aTt , Escrow Phone:
Email Report to-,
For Inspection call (Name): Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOw
vioiations are disimVered l will be resporrsibleto correct said violatlon3''
Owner/Agent's signature to authorize inspection: Date:
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Date: 9/22/2020
CITY OF NEWPORT MACH'