HomeMy WebLinkAboutR2020-0919 - Permit ApplicationPrint Farm
City of Newport Beads:rnr:!1 3i.
COMMUNITY DEVELOPMENT DEPARTMENT C',0ufJiUNITY"
BUILDING DIVISION UEVELOPIOr
100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA 92Fi38�1^�
RBR#_�2(7 - O9lq www.newportbeachca.gov (949) 644-3200
Application for Report of Residential Building Recordsrvor
Application Fee: - $194:00 Notice: �ykuoftr a PC
(For AIIResidential Buildings) Applications with insufficient fee payment
Reinspection Fee $129.00 or Incomplete will be returned
Please type or print and complete all information
# of Units: i- Address: '$�i %I City: Newport Beach State: CA Zip: Fq
Property Owner. Cmmc V V, &hoi d, rpo 7 Chvi
Owner Address:
State: ICA
Owner's Authorized Agent:
Agent Address:
Zip Code: �—
State:— Zip Code:'
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City:
City:
Agent Email Address:
Zip Code: F
Home Phone:
Work Phone: I qLp-Uj5— a
Escrow Company: f -do l LvtEscrow #:
Escrow Address: R Y - TV City:
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State: Zip Code: (/� D
Email Report to: I W OXTI r/t,7I 1 f
For Inspection call (Name): I N
Escrow Phone:
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 correct said violations.
Owner/Agent's signature to authorize inspection:
Date:
Owner/Agent's signature to decline inspection: Date:l 2'
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Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH