HomeMy WebLinkAboutR2021-0237 - Permit Application�xtrCENtb GY
;oMMt1NITY
City of Newport Beach uiNF-LOPMENT
COMMUNITY DEVELOPMENT DEPAFVTMENT MAR `i ®ZOZ)
BUILDING OMSION
100 Civic Center Drive l P.O. Box 1768 1 Newport Beach, CA92656-8915
Rg www.newportheachca.gov I (MS) $44-3200 ::ITYof
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Application for Report of Residential Building'Records oH; otPc
Applkia d'oo Feer.- �.q a • Notices:
r(•Fuc,GIIBTesideni3al,Bui{dings)' Appiimti'artswith.rnsuflacientfe�"Lsaymecrt: '
Rernspection•F�ee::$,22! =: will:be;ii kt riled
Please type or print and complete all information
# of Units: F0 Address: city: Newport Beach State: E171p:
owner Address:
State: �� Zip Code:,
Zip Code:.
city. I roaS�
Home Phone: tt6t 71LO
Owner`s Authorized Agent �Work Phan,: L tj 5,e� L
Agent Address: C •�. Oty: o -w -
State: ISL—J Zip Code: Oi VUL10 . Agent Email Address:
Email Report to:
For Inspection call (Name): Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
F author ze imspectroris.and re=iiaspechion'softhe property fisted above. I uodersland-that.if Buridinger Zonlhg.
vrolationsare.Efiscovered:l w'!U:bd:resportsibl'eto correetsafd vrolatiens.
Owner)•Agent'ssfgnature•to•authorlr7x•insPediom: f Date,
Docu6lgnejlr: Docby: .
Owner/�Agent'ssigrratureto daefine.'u°rspectrnm: E6v, `-FVYLpI.tMdLL �j c.1'vt Vit. aAYL .
D26 MEOSAE4588E05AE454...
Account # 01050504521040 ..... _......... Make checks payable ta: Crry OF NEWPORT.BEACN
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