HomeMy WebLinkAboutR2020-0335 - Permit ApplicationOocuSi velope ID: F8C467D2-D3BC-41AF-A9A7-471009E45D62
' I City of Newport Beach (:c�lvr ti Qr
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COMMUNITY DEVELOPMENT DEPARTMENT bF!-oPMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Bax 1768 1 Newport Beach, CA9265"152 2020
RSR#� ' 5-7, ,5 www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records'"roF
Application Fee: - $191.00 Notice: "%RT 30p'
(For All Residential Buildings) Applications with insufficient fee payment
Reinspection Fee $129.00 or incomplete will be returned
Please type or print and complete all information
# of Units: Address: 'j� } j'.Z �`�^ !� �� City: Newport Beach State: CA Z(p:
Owner Address: 5 �, If Z
State: CA Zip Code:Z� 7
�►J •�-� Zip Code: RZ,`;o2S
City:
Home Phone:
Owner's Authorized Agent: Work Phone:ii--N�.�N �, 1
Agent Address: 1100b A,. CAW v%- c... City: �jC,t Y�O.G ts.�___✓� .
State: C �_ Zip Code: — ZZUlt0 Agent Email Address:
Escrow Company: ('�chwt\, Escrow #:
Escrow Address: City:
State: ^ Zip Code: L U (Pp Escrow Phone:
q_yq. 220. ► oz a _.
Email Report to:���.�, _� t„ __ ale �1 _.x.Y��• l� �c�_ —�
For Inspection call (Name): N ` Direct Phone:
CONSENTTO 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
DOYYSIQned by:
Owner/Agent's signature to decline Inspection: r � � Date: --4/21/2020 —
AC7336C5EDEA436...
Account# 01050504-521040 ................. Make checks payable to: CITY OF NEWPORT BEACH
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