HomeMy WebLinkAboutR2022-0144 - Permit ApplicationRgCEIVEO e
COMMUNITY
DEVELOPMENT
uw Prlht°aorm ' City of Newport Beach MAR 17 2022
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
Q
100 Civic Center Drive P.O. Box 1768 1 Newport Beach, CA92658-891tiTYCF
RBRN www.newportbeachea.gov 1 (949)644-3200 4,
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Application for Report of Residential Building Records
Application. Fee: -$19800 - .. - Notice:.
:.-(For Ail Residential Bulidings) - - Applications with lnsufficientfeepayment
- Reinspectlon Fee$131;00 - orincompletewllibe returned ,
State: CA - ;Zip Code: I Home Phone:
`—
Owner's Authorized Agent: Work Phone:
..Agent Address: City:l
:State: L� ;Zip Coders
AgeritEmail Address.
:Escrow Company. �C.
!!
escrow Address: City:
'�ta_S�E ��Q....� 7-7c1�/2-Q
State G',rt� :Zip Code: Escrow Escrow Phone 911/q7,,�Jl'Q�
Email Report to: J,j1VE}7/�]C�CEY(T/✓CeSGK'dWe:�0Y1�_,.,._, _. ._ —.____...._r
For Inspection call (Name): I Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED &.DATED BELOW)
I authorize Inspections and re -Inspections of the property listed above. Iunderstand that IfBuilding orZoning.. -
violations are discovered l will be responsi61eto correctsaid viollattiioCns:.
owner/Agent'ssignature to authorize Inspect it_ 0PEC-'-j(,--,Pate:
,/� ---OR DECLINED
Owner/Agent'ssignature to decline inspection: ,,-i..Li Date:��,.
Account 401050504-521040
oupLingmmnan\rmmi�eex i.r-ss
to: CITY OF NEWPORT BEACH
Please typeor print and Complete
all information-
it of Units: Address: _
liilGte .]i YI Ue . _
:City: Newport Beach]] State:
CA Zlp:
State: CA - ;Zip Code: I Home Phone:
`—
Owner's Authorized Agent: Work Phone:
..Agent Address: City:l
:State: L� ;Zip Coders
AgeritEmail Address.
:Escrow Company. �C.
!!
escrow Address: City:
'�ta_S�E ��Q....� 7-7c1�/2-Q
State G',rt� :Zip Code: Escrow Escrow Phone 911/q7,,�Jl'Q�
Email Report to: J,j1VE}7/�]C�CEY(T/✓CeSGK'dWe:�0Y1�_,.,._, _. ._ —.____...._r
For Inspection call (Name): I Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED &.DATED BELOW)
I authorize Inspections and re -Inspections of the property listed above. Iunderstand that IfBuilding orZoning.. -
violations are discovered l will be responsi61eto correctsaid viollattiioCns:.
owner/Agent'ssignature to authorize Inspect it_ 0PEC-'-j(,--,Pate:
,/� ---OR DECLINED
Owner/Agent'ssignature to decline inspection: ,,-i..Li Date:��,.
Account 401050504-521040
oupLingmmnan\rmmi�eex i.r-ss
to: CITY OF NEWPORT BEACH