HomeMy WebLinkAboutR2022-0305 - Permits (2)�,4�EIVEp @y
Print Form City of Newport Beach COMMUNITY
COMMUNITY DEVELOPMENT DEPARTMENT DEVROPMENT
BUILDING DIVISION 1tJN 2 2 2022
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
RBR#T\4000' '/X/l www.newportbeachca.gov 1 (949) 644-3200 CITVOF
Application for Report of Residential Building ReccW4166.,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
#of Units: 1 Address: 310 Orchid Ave I Oty: Newport Beach ! State: CA 'iZip: 92625
Property Owner: - Zip Code:
Ojvner Address: City:
O_._
Sate: CA Zp Cbde F—, Fbme Phone: l'il O� I �`�
Owner's Authorized Agent: Pam Fecher % Work Phone: 949-702-4400
Agent Address: 32451 Golden Lantern, Suite 210 aty:1 Laguna Niguel
Bate: CA Zip code: 92677 Agent Email Address: pam@pamfecher.com
Finail Fbport to
For Inspection call (Name): D rect 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 l will be responsible to correct said violations.
Owner/Agent's signature to authorize inspection: � -pate
OR
Owner/Agent's signature to decline inspection:
Date: I
Acoount # 01050504-521040 .................Make checks payable to: OTVOFNEWPORrMCH
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