HomeMy WebLinkAboutR2022-0285 - PermitsCity of Newport Beach 0 dAv SGY 1
CDMMUNrFY DEVELDPMENT DEPARTMENT
BUILDING DMSIDN
1DD Civic Center Drive I P.O. Box 1768 1 Newport Beach, CAP2655-8915 (N:
kH C' www.newporfbaachm,gov 1 (949) 644-32DD �CEIVED eY
COMMUNITY
Application for Report of Residential Building Records DEVELOPMENT
knplicatib� ree::- 7 �q-I NDticez; JUN 0.9 2022
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# of Units: Address bf kyr-C, City; Newport beach State: CA Zip: y(�
Property
Owner Address:
State: CA
Zip Code:
00
\LItiV 5pcode.
crry: -4-. C,UI
Home Phone;
Dwner`s Authorized Agent: - q I
Work Phone: Gl r•,-��i �( (� r'^�(Q (,Q-�
Agent Address: �� N (+�( 'tC.V 'D\(C�1*�L �Cty: +
state: Zip code: Agent Email dd a s•
Email Report to; I Z 'p LJ.L�LS1W k1 V j , (;y r i
For Inspection call (Name): Direct Phone: --�
CONSENT TO INSPECT(FDRM MUST HE SIGNED & DATED HELOWI
F'ar th'o ize inspections.andre=ii sPechion'safthe property fisted shove. I anderstand-tlratrf 5u.AdingwZonFng
vralatinnsare d scot a ed'I n illlie respnns hl'eto correctsaid violations.
Owner�Agentssignature•toautharrze irtspe�tiam:
Owner/Agent's sigrratur.Fta
Date:.
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Account # D1QSD5D4-S21D40 ----------------- Make checks payable tar CITY OF NEWPORT BEACH