HomeMy WebLinkAboutR2023-0368 - Permit ApplicationPrint Form
City of Newport Beach RECEIVED By
COMMUNITY
COMMUNITY DEVELOPMENT DEPARTMENT DEVELOPMENT
BUILDING DIVISION g 0 3 2023
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658- 15
Roo#_ V Zo7 3 - 03Ga www.newportbeachca.gov 1 (949) 644-3200 CITY OF
NEWPORT BEACH
Application for Report of Residential Building Records
Application Fee: - $202.00 Notice:
(For AIIResidential Buildings) Applications with insufficient fee payment
Reinspection Fee $134.00 or incomplete will be returned
Please type or print and complete all information
# of units: I— Address: IF
City: Newport Beach State: [CA Zip: Q (_
PropertyOwner:� VCL V01 ✓ l tliWrF' D
Yi• Zip Code:
Owner Address: j' Tui!on City:
State: CA I Zip Cod'e:l. U („ HomWeVPhvornver: ?' qj.
Owner's Authorized Agent: I lG� v Work Phone: Fqql. ' //t/t Utom( 1
Agent Address: n1.nn1 �/��fQ n O City: i
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State: Zip (Cood`e: /`w t• V
IA 71. Agent Email Address:
Escrow Company: l W 1VV Escrow #: �8 Q
Escrow Address: /y)h� (,/i/�/yV�ji Vo City: (1111i%�h/� Yy
State: VYS Zip Code: I 1 .11 Escrow Phone: � ,
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Email Report to:
For Inspection call (Name):
Q,�.ewn
Direct 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 I will be responsible to correct said violations.
Owner/Agent's signature to authorize inspection:
Owner/Agent's signature to decline
Date:
Zoe 3
Account # 01050504-521040
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