HomeMy WebLinkAboutR2023-0465 - Permit Application® RECEIVED BY
City of Newport Beach COMMUNITY
COMMUNITY DEVELOPMENT DEPARTMENT DEVELOPMENT
BUILDING DIVISION MAY 2 6 2023
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
RJR#_Q20Z 3 Oy SP $ www.newportbeachca.gov 1 (949) 644-3200 CITY OF
NEWPORT BEACH
Application for Report of RPcir1Pntinl Qiaill;. - D-- J�
Application Fee: - $202.00
(For All Residential Buildings) Notice:
Applications with insufficient fee payment
Reinspection Fee $134.00 or incomplete will be returned
Please type or print and complete all information
# of Units: F Address: a�( I' 1 City: Newport Beach State: CA Zip.
n uyei iy uwnecl 1 In \ Zip Code:l
Owner Address: ��I-^" I 1'
` I City:
State: CA Zip Coder Home Phone:
Owner's Authorized Agent: J Work Phone: �—
Agent Address: City:
State: L J Zip Code: L
Agent Email Address:
Escrow Company:
Escrow #:�i
Escrow Address: J—R" �����(£'—'--S.YLl9,�ryi r I City:—✓_..t—�
State: l(vA I� "O-_.JVp Code: 9l%
I — I Escrow Phone:
Email Report to: m�� /'Drl >L� nr nn,._.� _ Jill_ .-. n.. _�. _ .
For Inspection call (Name): _ -- 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
Date:
Date:
Account # 01050504-521040 .................Make cheyirs payable to: CITY OF NEWPORT BEACH
Budding Division\Farms\RBR 6-15-22