HomeMy WebLinkAboutR2020-0858 - Permit ApplicationFlECE1Vl;O
City of Newport Beach coMMUNrry
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION OCT 0 7 RECD
��fp_ (100 Civic Center Drive P.O. Box 1768 1 Newport Beach, CA 92658-8915
RBR# ��" �d f0 www.newportheachca.gov I (949) 644-3200 n� OEVELOpMENT
Application for Report of Residential Building Records OA'A �PO�
A9GIiEatiO6 Fee::-$: I 1 1-i Natic
.({cc'AII�R;esrdential.BuildYngs)' Applicatronswith.insv�c%ntfeepayrnent:
Rernspection• Fee:$,129:U0: ar iirmmple@e will:6e; iieturiied
Please type or print and complete all Information
# of Units: E-1Address: City. Newport Beach State: Zip: 9 %
WME'�1190001vy kNEE
Email Report to:
For Inspection call (Name): Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
P authorize inspectrons.andcrinspection's of.'the property listed above. I undecstand-that.if 6u.'rJdingerZoning.
vro.lationsare-discovered'I Will be:responsibl'eto correctsaid violations.
Owrter/'Agent's signature•to•authe�xe�insPedaam:
Date
OR
Donuslgned by:
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Owner/Ageat'ssigmatur6to deciree.Impectibe: -rye, r A�Lsl Date:: . •�-
--330A07F823790C3...
Account # 01050504-521040 .................Make checks payable to: OTY OF NEWPORT atAQ7
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