HomeMy WebLinkAboutR2020-0850 - Permit ApplicationRI:CEIVF4
19) -
City
City of Newport Beach COMMUNITY
COMMUNITY DEVELOPMENT DEPARTMENT OCT -1 RECD
BUILDING DIVISION
0p 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA926w_-88EIVELOP
RBR#l^ZOZO Q�S� www.newportbeachca.gov 1 (949) 644-3200 L Ni Z
G
OA- Otic
Application for Report of Residential Building Records ""Fun'
Aaiiti -t n.Fee:-$194,00 Notice:(
(ForylfFtesidentialBuildings) Applications with insufficientfee payment
Reinspection Fee $129.00 or incomplete will be returned,
Pro perty Owner: { �{ r _ Zip Code:
Owner Address:9Cit Y.
State: CA Zip Code: �6 Home Phone: _ j
Owner's Authorized Agent: Work Phone:
Agent Address: City:
State:F Zip Code: Agent Email Address:
Escrow Company: ^�YQ __\own ai: n r. _ 1 �...rF ----.. ,I Escrow #:
Escrow Address: tl��U �`'V'C, '(/ i VC2 I'�-'� DY:Ci�city:
State: -� Zip Cod J1 Escrow hone.
Email Report to: I �1-PN Wrr) esul't-r v ........\G'..'..'
For Inspection call (Name): f 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 l will be responsible to correct saidviolations
Owner/Agent's signature to authorize inspection: Date:
AOR. j
OwnerfAgent'ssignature todecRSAW decline it Date:
V
Account # 010.50504-521040 .................Make checks payable to: CITY OFNEWPORT BEACH
Building Division\Forms\RBR ]-30-20
Please type or print and complete all information
#ofUnits: Address:
---
�,� L �Qg City:
Newport Beach State:
,/
CA Zip:(�, �3 '!
-F �db
Pro perty Owner: { �{ r _ Zip Code:
Owner Address:9Cit Y.
State: CA Zip Code: �6 Home Phone: _ j
Owner's Authorized Agent: Work Phone:
Agent Address: City:
State:F Zip Code: Agent Email Address:
Escrow Company: ^�YQ __\own ai: n r. _ 1 �...rF ----.. ,I Escrow #:
Escrow Address: tl��U �`'V'C, '(/ i VC2 I'�-'� DY:Ci�city:
State: -� Zip Cod J1 Escrow hone.
Email Report to: I �1-PN Wrr) esul't-r v ........\G'..'..'
For Inspection call (Name): f 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 l will be responsible to correct saidviolations
Owner/Agent's signature to authorize inspection: Date:
AOR. j
OwnerfAgent'ssignature todecRSAW decline it Date:
V
Account # 010.50504-521040 .................Make checks payable to: CITY OFNEWPORT BEACH
Building Division\Forms\RBR ]-30-20