HomeMy WebLinkAboutR2020-0468 - Permit ApplicationPrint Form :!' City of Newport Beach
"MMUNITY
COMMUNITY DEVELOPMENT DEPARTMENT ;I,.oPMEr
BUILDING DIVISION
��y 100 Civic Center Drive I P.O. Box 17681 Newport Beach, CA92658-8915 1 `� 2Q20
RBR# . V www.newportbeachca.gov 1 (949) 644-3200
Annl(eatinn Mr Rennrt of Residential Building Rernrds :ITYOF
Application fee: - $191.00 .Notice:
'nHT i3�P
(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: .. „I (NL City: Newport Beach_ State: A Zip: qw
Owner Address:-•�\ City:
State: CA _I. Zip Code:
Owner's Authorized Agent:
State:
Agent Email Address:
Zip Code:.. G(�_....
Home Phone: 9qq y
Work Phone: —7` L- 4— -.:. 0_
Sqj v I �-A o C., `�1n�-"—r-\R
Escrow Company: Escrow #:
Escrow Address: City:
State: F— Zip Code: F— Escrow Phone: �—
Email Report to
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 orZoning
violations are discovered I will be responsible to correct said violations.
Owner/Agent's signature to authorize inspection: Date:F —
OR
I
Owner/Agent's signatureto decline inspection: `=' Date:
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
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