HomeMy WebLinkAboutR2023-0229 - Permit Applicationa 6 (to7 5&ow1 owe Dr
Print Form City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT RECEIVED BY
BUILDING DIVISION COMMUNITY
D�yELOPMENT
100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA92658-8915
Rm (L 20'Z3 — p 2-Z `k www.newportbeachca.gov (949) 644-3200 MAR 2 2 2023
Application for Report of Residential Building Records CITYOF
Application Fee: - $202.00 Notice: EWPORT BEACH
(For All Residential Buildings) Applications with insufficient fee payment
Retnspection Fee $134.00 or incomplete will be returned
Please tVpe Or print and complete all information
# of Units: Address ��// G^ �/�� _G City: Newport Beach State: CA Zip:
Property Owner: j�Q��n/-N1(/Lj�2/ T/�(J�'T Zip Code:
Owner Address: jl(ZI� PO/ZTWJEyg/w6C— 4L, City: 1/FWP(JgT- 115614t�E.(
State: CA.,. -...- Zip Code: Fq 6 o Home Phone: cf `.- —7/20 HS`{...._
Owner's Authorized Agent: I. _ -... Work Phone: I _.
Agent Address: City:
State: F Zip Code: F Agent Email Address:
For Inspection call (Name): I., ! 4,u L M U.-L-7FA R-.(.-. -.._-.
Direct Phone: ggq—j Ov _ m.-t_,�ii
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 I will be responsible to correct said violations.
Owner/Agent's signature to authorize inspection: / �� Date: F7--22-20zJ
Owner/Agent's signature to decline
in
Date: F—
Build'rn Division\Farms\RBR 6-15-22
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH