HomeMy WebLinkAboutR2022-0174 - Permit Application�C�ivEt�'ay
Ci of Newport Beach COMMUNITY
_ � p pEVELOPIuIENT
CDMMUNITY DEVELOPMENT DEPARTMENT APR 412022
BUILDING DNISIDN
1 DO Civic Center Drive I P.O, Box 176E I Newport Beach, CA92656-6915
RBR# �(. I www.newportheachca.yov 1 (949)644-32DD OrryOF
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Application for Report of Residential Building Records —'W(MT w•
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. (For. R11.4Tesideritia4.BPi{dings)' Appiii=atfonswith.ihsuf.Fcient'i;kp-payment:
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# of Un{ts: M Address: 111'-, OYk WQS l V Y City; Newport Beach State: E1Z{p:F'q ZQ
Property Owner. d A X v� &�Licg S ostAl Zip Code:.
Owner Address: WI d(-� Vii ,j Neu,' city: 0
State: CA Zip Code: '�✓ Home Phone; 1 91411
Owner's Authorized Agent e 1 I i p' e k Work Phone:
Agent Address:1'�>Lil V ( 1 City;
State: Zip Code: Agent Email Address: it l
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Email Report to:
For Inspection call (Name): Direct Phone: 17
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
Pauth'artze 1nspections.andrL4nspecdom-afthe property listed above. l understandthaLif B'uh,lirigorZoning.
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Owner/Agentssdgnatnre•toauthoiuzeirtspe:�iam_ DECL'.p E6 Date:,�l
Owner/Agent'ssirrrdture•ia deciine.inspection:
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Account # D1050504-521040 .................Make checks payable ta: CTTY OF NEWPORT BEACH