HomeMy WebLinkAboutR2021-0303 - Permit Application{pnntitar'a City of Newport Beach F\vEu s
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COMMUNITY DEVELOPMENT DEPARTMENT t„ OV'Vi CITY
BUILDING DIVISION 7Fvo opmF'rli
oq�o'/� 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92&5$-Vj�?1
RBR# d( VtCLL "�l www.newportbeachca.gov (949) 644-3200 A? t
Application for Report of Residential Building Recortift O
Please type or print and complete all information
#of Units: Address: 2525 E OCEAN BLVD. #6E ! Cit : Newport State: CrA 'Zi 92625
Clifford & linda Tones am. c
Property0wner: Zip Code:
Owner Address: 20 via Mantova City: hen derson,nv
State: CA Zip Code: 89011 Home Phone
_.... �. wl F-7-7-77- ....... .._ ..,.
Owner's Authorized Agent:I--,. -
�1 {��--�h-e-e 1N-�S--j-. Work Phone:
Agent Address: / I NO
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State:1-� Zip Code. SIG llll,Po Agent Email Address:. l�V
Escrow Company: v .1..._l✓1-.� l_,.. /.. l/. W -_._. Escrow H: , n. L.�......-(-. '� 2.__ JI J
Escrow Adddd�ress: LT0 „N-�/y� / ,,p r-�— City: N C. h �✓ -- --.
State: Zi Code: v" ' '„��r Escrow Phone: "I�(7 �%� 2
Email Reportto. I ' d o n.-n� I I/.��C�y -.- �I 1 Q..{'1 l+'"�-PSCr.� w ,..0
For Inspection cal"IZi�J�i ame): t 1 _ _.. Direct Phone: N,I,
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
I authorize inspections and re -inspections of the property listed aboveI understand that if Building or Zoning
violations are discovered I will be responsible to correct said violations..'
Owner/Agent's signature to authorize inspection: //fi�nn Date:
/' Docua fined QR
Owner/Agent's signature to decline inspection: Gerd J6�s Date: aaa�naae�®rn®I
Account f# 01050504-521040 .................Make checks payable to: CITY OF NEWPORT REACH
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