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HomeMy WebLinkAboutR2021-0431 - Permit ApplicationPnnt Form City of Newport Beach COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915 www.newportbeachca.gov 1 (949) 644-3200 Application for Report of Residential Building Records Application Fee: -$194.00 Notice::. (For Ali Residential Buildings) r Applications with insufficient fee payment Reinspection Fee $129.00 or incomplete will be returned Please type or print and complete all information kofUnits: F7 Address: Ub� .oC�New �o City: portBeach, State: ICAZipff;T"'} Property Owner: e: .Y-V,� _�\� �1 � C� 1 v� Zip Code: Owner Address. ( fib U P,�,j 0 Co—City: State: Zip Code �� !3 Home Phone: Owner's Authorized Agent �0� '��'��, Work Phone: Agent Address:`'© �{�-� c14" City: State:(`�(�s Zip Code �, ALLtb i Agent Email Address: FTF Email Report to: I �(�C{��("'QQ�) �`Fr\.Q\cSe,C,6"131,e'�, Cvs)-t--� a. �1��—,�..1.��,. CMlJ. Las ',, For Inspection call (Name): Co\6 5ry' -\ 6 \ _ . _ Direct Phone: CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW) I authorize inspections and re -inspections ofth violations are discovered I will be responsible tc Owner/Agent's signature to authorize inspection: Owner/Agent's signatureto decline inspection: rope rty listed above. Iiunderstand that if Building or Zoning >rrectsaidviolations. Date: tx q.. R` Date: �® .vccount u U1UbUSU4-5Z104U .................Make checks payable to: CITY OF NEWPORT BEACH BUIIdm1Div 1w\Forms\RBR 7-30-20