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HomeMy WebLinkAboutR2020-0475 - Permit ApplicationCity of Newport Beach COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915 RBR# © '-" S www.newportbeachca.gov ( (949) 644-3200 Application for Report of Residential Building Records Application Fee: - $191.00 Notice: (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: '241 Cl/1�_+)PV '�) # sy City: Newport Beach State: CA Zip:�2(P� PropertyOwner] ,)'/O&�/ —KV <-1 Owner Address: SLIq k)ood s P�- City: State: CA Zip Code: g2�(eo Zip Code: Home Phone: 1�q`-(e-l) K7- q- -(�,-7 Owner's Authorized Agent: .PYA; -,O- Lke11 ooe rA- Work Phone: �— Agent Address: I SHO ft'ew roV"J-GLI M' /�Y`-F>Z/Docity: nL°l� �0 ✓f ��q eh State: Gf4- Zip Code:�iZt01P(] Agent Email Address: Escrow Company: I e"P/\�S i -_ Escrow #: Dcr-- -I — 4L 'n p Escrow Address: ��j� City: L,4:Z0Lv1ZL Mt 0-e I State: I c Zip Code: � -n Escrow Phone: 'o( 1 9G1 1 .-U'� 19- Email Report to: I-[::eA.WI t�)'Li C� @ i5V-P l� �VvJ, l J For Inspection call (Name): F Direct Phone: --_,_-- CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW) I authorize inspections and re -inspections ofthe 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: 1__ Owner/Agent's signature to decline inspection: Date: (6, Account it 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH 9uilding Division\forms\X6A 94818