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HomeMy WebLinkAboutR2022-0165 - Permit ApplicationRBR#=Z-0105 City of Newport Beach COMMUNITY DEVELOPMENT DEPARTMENT 00M1t;At;NI't' BUILDING DIVISION 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-891' www.newportbeachca.gov 1 (949) 644-3200 Application for Report of Residential Building Please type or print and complete all information #of Units. Address: a5`%J% 2_ _LOQ QS City: Newport Beach! State: CA Zip: Property Owner:par;ck Code:Ut1��Qn . Zip CqG Owner Address: 17CAMl)Oo �11T'. City: ►Ju.+for�....� ---.. State: CA _ Zip Code: �aGGo Home Phone: Nl�r77 Owner's Authorized Agent: N Ik Work Phone: Agent Address: City: State: � Zip Code: Agent Email Address: Escrow Company: [$Crotsl Escrow#: OSSa(vo—"�LJ re�tlo -- Escrow Address: 12op City:,cv ofk AGh _ State: ' Zip Code: - Escrow Phone: _ —C>l9 gd(�Go Email Report to: W �✓�_�( YlM �.�f f1. � _aoM for Inspection call (Name): Direct Phone: CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW) I authorize inspections and re -inspections of the property listed above. I understand that if Building or Zoning violations are discovered [will be responsible to correct to TION Owner/Agent's signature to authorize inspection: DECLINED Date: AOwner/Agent's signature to decline inspectionDater` (' nLcuum x U1U3UDU4-DZ1V4V .................IVICKe cnecKs pGy001e LO: UI r OF rvtwrUHI BtACH emeing Dmision\roans\RBR_7-1-u