HomeMy WebLinkAboutR2020-0915 - Permit Applicationc CAIhiODi I!! IT
` tPri!,t'`ri� v City of Newport Beach
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COMMUNITY DEVELOPMENT DEPARTMENT OCT 112 MID
BUILDING DIVISION 4. Ei MID
nn 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658 -,BMF
RBR# R MO -0q15 www.newportbeachca.gov 1 (949) 644-3200 OF
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Application for Report of Residential Building Records w;a•t
Application Fee: -$191.00 Notice:==
(For All Residential Buildings) Applications with insufficient fee payment
Reinspection Fee $129.00 or incomplete will be returned
#of Units: I Address:
Please type or print and complete all information
City: Newport, Beach State: CA Zip:. ---_i
Owner's Authorized Agent /'� _-�{'1--1 r- Work Phone:
Agent Address: 9 Corpo r Q+�_.. P I �---_ City:
State:C( q Zip Code: Q 21..V v Agent Email Address:
Escrow Company: 1.� I 111_I ' l+� -� 1,-.1--._O W Escrow #:10
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Escrow Address: Fi5o Few p o. r-1- City:
State: ,�� Zip Code: f no 1,—e�t�r Escrow Phone:
Email Report to:
For Inspection ca
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CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
I authorize inspections and re -inspections of the property listed above. l understand that if Building or Zoning
violations are discovered l will be responsible to correct said violations:
Owner/Agent's signature to authorize inspection: ' - rr.��Date: �-
DCCu3 Rd by
Owner/Agent'ssi nature to decline inspection: �� 10/16/2020
6 P �.�.. Date
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Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
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