HomeMy WebLinkAboutR2021-0172 - Permit ApplicationJ
Cit of New ort Beach \*GVVEC) by.
' City p COMMUNITY
COMMUNITY DEVELOPMENT DEPARTMENT DEVFLOiaMGNT
BUILDING DIVISION
��{ {100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8dW O 5 2021
�� www.newportbeachca.gov 1 (949) 644-3200
CITY OF
Application for Report of Residential Building Records,,.
Aoolication Fee:: $191.00 Notices: PORT V�
(For All -Residential Buildings) Applications with insufficient fee payment:
Reinspection Fee.$ -129.00 :- or incompletewill: be returned'
Please type or print and complete all information
# of Units: C Address: �� (City: Newport Beach State: CA Zip:
Property
Owner Address:
State: CA
Zip Code:
V I
Phone: I
Owner's Authorized Agent: Work Phone: 3I 7
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Agent �iAd/dre�ss':�''—� (/y� City: y)State: I 7T —' Zip Code:Agent Email Address:
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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/Agents signature to authorize inspection: Date:.
OR
Owner/Agent's signature to decline inspection: Date:.-.L�..-._--_-_.
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
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