HomeMy WebLinkAboutR2023-0419 - Permit ApplicationRECEIVED BY
Print Form City of Newport Beach COMMLINTrV
COMMUNITY DEVELOPMENT DEPARTMENT DEVELOPMENT
BUILDING DIVISION MAY 112023
100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA92658-8915
ftsit# X2-023 -O`il www.newportbeachca.gov (949)644-3200 CITY OF
NEWPORT BEACH
Application for Report of Residential Building Records
Application Fee: - $202.00 Notice:
(For All Residential 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: F6Z Address: L/ r/ j -,q c3 NZ) /i ( City: Newport Beach State: CA Zip: 26 loJ
Property OwnerryV A)L' L- I t?.l.�-/ Cfj� ` s ue Zip Code:F�,�'�2
Owner Address: �� ✓ (� N /,( L1) Ty 5 j 1 _ City: t
State: CA Zip Code. % 3 z / Herne
Owner's Authorized Agent: jo 1.( N u -... _
Work Phone:
Agent Address: 799 L/l)t,A) jGL apt;City:
State /'. L7 Zip Code. (7//', Agent Email Address:
J 6 H10 A)' ., y 0 7(� /+2 19 r ( eO,44
Escrow Company: E T /(D C-5(t e p iz)
- Escrow #: T1 .1 - 69 7 /�
Escrow Address: 3� 0 b (lii �gN1i2e�jLJbe city:
Los a
State: 7111 � Zip Code: ! D v/ D
1l5
Escrow Phone: �C (J%- y;117 • 3 6o b
Email Report to: ,j p ){ /„7 ti V. `{ Cq 0 � Aq A A,(
For Inspection call ame): .JO t}N�U „ L( _)
u - _-- -
Direct Phone:
r�aa
I authorize inspections and re -inspections of the property listed above. I understand that if Building or Zoning
violations are discovered Iwillberesponsiblex correct said violations. 1
Owner/Agent's signature toadtYffprizeinspecti_\ i' "v/� . %%�•� Date:��
U /
OR
Owner/Agent's signature
Date:
Building DWW.a \Forms\RBR_6-15-22
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH