HomeMy WebLinkAboutR2020-0558 - Permit ApplicationPrint For City of Newport Beach sy.
COMMUNITY DEVELOPMENT DEPARTMENT C0iv9MUNITY
A wAA `` BUILDING DIVISION DEVF1 OrNI NI
Qq Civic Center Drive P.O. Box 1768 1 Newport Beach, CA9�5WJ9�R20
RBR#A(�/W 05swww.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Reccli&OF
Application Fee: - $191.00 Notice: 'SWPCIRT 13-0r
(For All Residential Buildings) Applications with insufficient fee payment
Reinspection Fee $129.00 or incomplete will be returned
Please tvve or print and complete all information
#of Units: EJ Address: 049l Nrf- Ndun Place, city: Newport Beach State: CA Zip:
Property Owner: Orgq Mi HIM Maas bvtn*�z us4- Zip Code:
Owner Address: City:
State: CA Zip Code: Home Phone:
Owner's Authorized Agent: ��hi`Y1�C�Gh S YLIL'-(J Work Phone: qr{c( — (03&—
Agent Address: 3 `I side, Drive Swfctoo City: -,q DY I [.'ecd)
State: Zip Code: Agent Email Address: P (1t" & rglLe-&VrO
Escrow Company: I6Le W o- er EC -P o"l I Escrow #:T.() -- -76 �0— (i M
Escrow Address: M0 Ne(•il,bri 0"&—.et lYiv- Pity ,w urf 9 fe--2ch 77
State: Zip Code: Escrow Phone: I q"-- 47K---7L(bD
Email Reportto: I til t,6l:n (®J 00-e I,04 -Te& GW. Cb-rn
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 correctsaid violations.
Owner/Agent's signature to authorize inspection:
Owner/Agent's
Building Division\F.l.SNRBR 9-18-18
Date:
Account # 01050504-521040 .................Make checks payable to: OTYOFNEWPORTBEACH