HomeMy WebLinkAboutR2020-0894 - Permit ApplicationDocuSign Envelope ID: 7A330014-8853-43EE-B95F-92749D074235
�nntorr+ City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
400 Civic Center Drive I P.O. Box 1768 Newport Beach, CA 92658-891
www.newportbeachca.gov (949) 644-3200
Application for Report of Residential Building Records��/��\�
Aaplication Fee - 5 19 4 4 , 00 Notice:
(For: All Residential Buildings). ;Applications with insufficient fee payment
Reinspection Fee $129.00 or incomplete will be returned'
Please type or print and complete all information
of Units: E Address: New • Gity: NewporC Beach State: CA Zip:
roperty Owner:`fes' Cr� -7 Zip Code: v
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)wnerAddress; d ! City: [+r) j$ lis 'A-)
tate: F777 Zip Code: Home Phone:
)wner's Authorized Agent: f (� >':/ *� y/ work Phone: IL.> l ]
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\gent Address: 1_tCY{ City:
,tate: — Zip Code: Agent Email Address:
scrow" Company:
3scrow Address:
itate: M
Email Report to:
For Inspection call (Name): Direct Phone:
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CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELbw1
Iauthorize inspectionsandre inspections of the propertylistedabove.lunderstandthatiifBuildingorZoning
violations are discovered 1, will be responsible to correct said violationsi`•
Owner/Agent's signature to authorize inspectionua p ,, /�, ,,, , „ - Date:
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OR,
Owner/Agent's signature to decline inspection:. Dater_
Account #:0105 05 04-5 21040 ........... -... Make checks payable to: CITY OF NEWPORT BEACH
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