HomeMy WebLinkAboutR2022-0358 - Permits��.CEIVl'b
Gity of Newport Beach COMMUNITY
CDMMUNrTY DEVELOPMENT DEPARTMENT DEVELOPMENT
BUILDING DIVISION JUL 15 2022
D Civic Center Drive I P.O. Box 176E I Newport Beach, CA92655-8915
RBR# www.newportbsachca.gov l (949) 644-a2DD
CITY OF
Application for Report of Residential Building Records
+ ,6'pli ws6.® Feeir: $•f '.Q %. Notioe:;
. (Fo[AIL4:'esideritiab.Bui{dCrsgs)' Appticati'ons with.irtsnf.Fi�ient'Fee pa Yin nt
Reinspecion Fe' 1$173:D[J� prtncomplette will:6e;nefaimed'
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# of Units~ Address ._ q ZO N � q lI oO State: ICA IT1p:I CT 2 P. C
Zip Code;.
state: 73p Code: Home Phone; 1 '0I LtR ?"?,o �(.) Zj
Owner's Authorized Agent Work Phone:
Agent Address:
I L#66
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State:
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Tip Code:
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Agent Em�SAdddrem;
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Email Report ta:
For Inspection call (Name): Direct Phone:
CONSENT TO INSPECT (FORM MUST gE SIGNED & DATED IFELOWI
tarrtli'arze inspections.andre=iisspechionsafthe property Iuted above, I understa d1-tfraLFf BuiidingwZoFling.
violatinrasare_discovered'I t�rilT�Lie:respnnsihl'eto correctsaid vibfatinns. INSPECTION
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Owner�,4gents.signature•to author8ie•enspe�iare QaI V aFECU N EO.'.
OR
Dwner/Agent'ssigrratureLto deciine.inspectinc.:
Account # Q1050504-521040 ------ ._._---- -Make checks payable ta: CFFY OF NEWPOKT SFACH
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