HomeMy WebLinkAboutR2021-0349 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 ] Newport Beach, CA92658-8915
9L�ll L www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
Application Fee: - $194.00 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: F/7 Address: a �0 r a� City: Newport Beach State: CA Zip:F�4 0
Property
Owner Address: I gooa'Z
State: CA Zip Code:
Zip Code: g2(p3� l
City: I-agom Woods
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Home Phone: 95- 905a
Owner's Authorized Ageent::X /ai�V eer -Trt i'Yl Work Phone: %, (� qQ- 7370
Agent Address: 3�SIlJiXs� i�W�_---- --� City: t-41una Reach
State:Zip Code: gal.PSI Agent Email Address:
Xavter rcaleS+ule xav►'er eery
Escrow Company: Pti k�ord ESC"w Escrow#:
Escrow Address: /y95�eljn-q City:L..CCyuna k9eaC,h//'7'-
State: ®Zip Code: 9,2U5I �7 Escrow Phone: %- !,—q&77
Email Report to:
For Inspection call (Name):
esc vj . caw,
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Direct Phone: J
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
perty listed above. l understand that if Building or Zoning
ect said violations.
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
Bullding_Dlvision\FoFms\BBB J-30-20