HomeMy WebLinkAboutR2023-1033 - MiscRECEIVED BY
COMMUNITY
DEVELOPMENT
DEC 0 4 7023
Print Form City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT OI
BUILDING DIVISION INEINFiOlU BEACH
100 Civic Center Drive I P.O. Box 17681 Newport Beach, CA92658-8915
RBRB 3 " 3 www.newportbeachca.gov 1 (949) 644-3200
Application Fee: - $208.00
(For All Residential Buildings)
Reinspection Fee $139.00
ication for Resort of Residential Building Records
Notice:
Applications with insufficient fee payment
or Incomplete will be returned
Please type or
print and complete
all Information
O of Units:FT
Address:
I City: Newport Beach State:
A Zip:
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Property Owner: —re— I—d i`5 J 1 1 U wi-' v0 Q U �tibJ /'l C/l/Ij Zip Code:
Owner Address: 2-02-5 V 1 s a � rOrj CIA': �" �aa _-_b .._. _—_.__
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State: CA Zip Code: O Home Phone:
Owner's Authorized Agent: L o $T— / — Work Phone: lv�— YJ y — 520
Agent Address: e rl _ 1� City: I e wpo rf
State: F Z„ Zip Code: 9f Agent Email Address: (', e— ecien S
Escrow Company: S aC m 6 (-e j[ O Escrow #:
Escrow Address: I 197b0 1--�j T j )4 ,6L City:
State: F� Zip Code: �' w Jt0
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Email Report to: I aq f -e e r i,
— For Inspection call (Name): F—
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Escrow Phone: I / 1 7.1377 _
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:
Date:
OR
Owner/Agent's signature to de`c aline �"� ` Date:
Account M 01050504-521040.................Make checks payable to: CITY OF NEWPORT BEACH
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