HomeMy WebLinkAboutR2021-0307 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
RBR# WW 5 www.newportbeachca.gov 1 (949) 644-3200
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Property Owner: �,Ct Rl�l v Zip Code: � 5
Owner Address: @9wCity'
State: CA Zip Code: ��.� Home Phone: _
Owner's Authorized Agent: Work Phone:
Agent Address: _-. _ _J City:
State: Zip Code:
Agent Email Address:
Escrow Company:( Escrow #:
-q
a
Escrow Addres:s� __ar,&V VCity:
State: Zip Code:..'�
----
Escrow Phone: _
Email Report to: I J�Q /✓.„�ne,�,�y �,G'lt—�
For Inspection call (Name): _.� 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 correctsaid violations
Owner/Agent'ssignature to authorize inspection: Date:
OR Owner/Agent's signature to decline inspection: /� V Date:
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
Building Mvlsion\Forms\RBR_7-30-20
Please type
or print and complete
all information
#ofUnits: I ' I Address:
to �'
lgfq__1t' x _.
City: Newport Beach State:
CA Zip:
-la"�d`J{ _.
Property Owner: �,Ct Rl�l v Zip Code: � 5
Owner Address: @9wCity'
State: CA Zip Code: ��.� Home Phone: _
Owner's Authorized Agent: Work Phone:
Agent Address: _-. _ _J City:
State: Zip Code:
Agent Email Address:
Escrow Company:( Escrow #:
-q
a
Escrow Addres:s� __ar,&V VCity:
State: Zip Code:..'�
----
Escrow Phone: _
Email Report to: I J�Q /✓.„�ne,�,�y �,G'lt—�
For Inspection call (Name): _.� 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 correctsaid violations
Owner/Agent'ssignature to authorize inspection: Date:
OR Owner/Agent's signature to decline inspection: /� V Date:
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
Building Mvlsion\Forms\RBR_7-30-20