HomeMy WebLinkAboutR2020-0962 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
CnA�
BUILDING DIVISION 4U/V/7-V
100 Civic Center Drive I P.O. Box 17681 Newport Beach, CA9265"�1f 16
RBRjf 0 01— www.newportboachca.gov 1 (949) 644-3200 0 RECD
Application for Report of Residential
Application Fee: $194.00
(For All Residential Buildings)
Reinspection Fee $ 129.00
Notice:
Applications with Insufficient fee payment
or Incomplete will be returned
Please tvRe or print and complete all information
# of Units: F ... Address: [j,qZ. :jC�pkzRgzoj -L4--2qA city: 'i Zip: F�QU3
- — ----- ---------- ----- INewport Beach State: FCA
Property Owner:I-AnyannA-dA ---
F cza I Zip Code: I--- -
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Owner Address: City: ibnacLu
State: Y Zip Code; Home Phone:
Owner's Authorized Agent: Work Phone:
AgentAddress: City.
State: Zip Code: Fq-zuol Agent Email Address: GA4jf_ZJsl-tn ().q 6t:!) ccovil, 60 fh
Escrow Company: 16k2r-) (04k:5 Escrow #:
I
Escrow Address: e��:LK4?4 RA. 4-zos- City:
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State:FC—A' Zip Code: tq:?�U,71 1 Escrow Phone: -ZS - (,7S-
Emaillieporttod
For Inspection call (Name): Direct Phone:
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/Agent's signature to authorize inspection:
Owner/Agent's signature to decline inspection:
KJ
Amanda Kathryn Grey
Date: F
Datel 11/16/20
Account # 01050504-521040 .................Make checks payable to: CITY OF ffwpoitm4w