HomeMy WebLinkAboutR2021-0183 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92659-6915
Rg ( ® www.newportbeachca.gov I (13M9) 644-3200
Application for Report of Residential Building Records
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#of Units: FT Address: V city; Newport Beach Slate: ElZip: tu��
Property Owner. Zipeodm, G�'•Z(Q�(!
OwnerAddres: I '(Y'� Y•\V Qty: tVQ)�*��••. •�%�,�AG�
State:, CA Zip code: Home Phone: Gil, 1,, �U ` t- 1
Owner's Authorized Agent nnl-G c�.)�I Pi'( Work Phone: .� I
Agent Address: b . • _ t r4 r. , City:CN" I" �3 e a
State: Zp Cede: ((G ,Agent Email Address: (' vio5vrvle' r Y7�
Email Report to:
For Inspection call (Name): Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
t'amthnrfze lr=pectrons.and ce�fiaspectionsafthe property fisted above. I understandthat.it BU.iiding or Zonfhg.
violations arediscovered'I Wilfbe respnrtstbl'eto correctsal'd vblatians.
Owner/AgDnGs;ignatum'ty authenFze inspechiore
Ooauftned byOR
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Owner/;4geeC'ssigmature•tn daeiiae.Usspectiba: Date:
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Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT. BEACH
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