HomeMy WebLinkAboutR2022-0311 - Permits (2)4OEivE'G 13y
Print Form City of Newport Beach COMMUNITY
COMMUNITY DEVELOPMENT DEPARTMENT DEVELOPMENT
BUILDING DIVISION JUN 2 ; 2022
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-891
www.newportbeachca.gov 1 (949) 644-3200 CITY OF
Application for Report of Residential Building Rec �Pc�
Application Fee: - $198.00 Notice:
(For All Residential Buildings) Applications with insufficient fee payment
Reinspection Fee $131.00 or incomplete will be returned
Please type or print and complete all information
#ofUnits: z Address: '�.�.' City: Newport Beach State: CA '..Zip: 92c��5
Property Owner.. _..n. �� I �.... ,YIV (. L1fl j...... _ ` t Zip Code: 2�� _..
Owner Address: TS� �u\ko l �l cjt _ City: C04OL 1AEJa/
State: I" Zip Code: �.'��'� Home Phone:(..
Owner's Authorized Agent: y) U tI b � L W ` 1 K Work Phone:h� I({[�
Agent Address: l vi 5 ✓'� Q� l [I � Qi 1 City:.
State: F Zip Code: C� `� t [ Agent Email Address: d I� (� ►< Zvi C �tYi (l i . i fl y�
Escrow Company: q _taLonn.l 1i�11� Escrow#: flV�-_�2�22Q(7a^r
Escrow Address: {��C7 �ul,(1 City: _�o�
State:. Zip Code: 5 5 1�~ Escrow Phone: 621 -10h
Email Report to: I . kI C(L @ VvJ a Cdth
For Inspection call (Name): Direct Phone:
CONSENTTO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
l authorize inspections and re -inspections ofthe property listed above. I understandthat if Building or Zoning
violations arediscovered l will beresponsibleto correct said violations.
Owner/Agent's signature to authorize inspection: I NSr LCTIp. 114
OR DECLINED
Owner/Agent's signature to decline inspection: 9V6,j 1A��O. Date: to i� 1�
Account It 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
Wding_ddsio \Po \RBR_7-1-21