HomeMy WebLinkAboutR2020-0879 - Permit ApplicationPrint Form
City of Newport Beach ED 13;
COMMUNITY DEVELOPMENT DEPARTMENT „`'.e'v1llNrTv
BUILDING DIVISION 9FvELOPNIEN
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA9265�18p 5tq 2070
RBR# V www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records rrvr,
Application Fee: - $39.00. 14. L(-, Notice:
(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: Fl Address:` �� City: Newport Beach State: CA Zip: `wul
PropertyOwner: -5-�WiY C Y � DY11 �. � � Zip Code: F -
Owner Address: City:
State: CA Zip Coe: F-- Home Phone:
Owner's Authorized Agent: K-V(ti f) �,W\ UVW( 1 Work Phone:
Agent Address: City:
State: F Zip Code: F Agent Email Address:
Escrow Company: -� � Escrow #:--�("
Escrow Address: m W �v City: '1�Uy In
State: I D4 Zip Code: R�l.J Escrow Phone: 1- 1,501
Email Report to: 3 lUw(li C I�JI Y 1 L�� /U ( � I I V11&NX..aU� r y, c
For Inspection call (Name): I Milt Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED& DATED BELOW)
I authorize inspections and re -inspections of the propertylisted 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:
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Owner/Agent's signature to decline inspection: Date: op ptw
Account # 01050504-521040 .................Make checks payable to., CITY OF NEWPORT BEACH