HomeMy WebLinkAboutR2020-0531 - Permit ApplicationDocuSign Envelope ID: ODA26A97-5EBC-40OD-AD3A-9DE45A51GFGG
Print Form = City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT , G LVED &p
BUILDING DIVISION
OMFflUNITY
100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA926j§P'6 4ENT
RBR#�fC>55 www.newportbeachca.gov (949) 644-3200
JUN 3 0 2920
Application for Report of Residential Building Records
Application Fee: - $191.00 Notice: GI"CY qF
(For All Residential Buildings) �
pplications with initi %u'" pay
ment
Reinspection Fee $129.00 or incomplete will be returned
Please type or print and complete all information
I -._._J
# of Units: Address: 2915 CASSIA STREET �'� City: Newport Beach State: CA Zip: 92660
PropertyOwner:_-IOHNANDLESUEANN-HARTY _ _� Zip Code F
Owner Address: 2915 CASSIA STREET City: NEWPORT BEACH-
--.._..---
State. CA - ._ Zip Code: 7M60 Home Phone _ 9499816500 __..__.-------
Owner's
-
Owner's Authorized Agent: jon di shon
Agent Address: 4.11. 30th street
Work Phone L141.177.9314
City: Fewpo
rt Beach
State: ca Zip Code: 2660 dishon@arborrealestate.com
Agent Email Address: U
For Inspection call (Name):Y Direct Phone:
john Hart 9499816500 i
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 responsibleto correct said violations.
Owner/Agent's signature to authorize inspection:
Date: 1 6/30/2020
OR
Owner/Agent's signature to decline inspection: lgil Date: 1 6/30/2020
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
Building Division\Farms\RBR 9-19-18