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HomeMy WebLinkAboutR2021-0174 - Permit Application_�] City of Newport Beach coMrauNiry I" COMMUNITY DEVELOPMENT DEPARTMENT )EV/ELOPMEN1 BUILDING DIVISION MAR 0 8 2021 6 Q1I100 Civic Center Drive I P.O. Box 17681 Newport Beach, CA92658-8915 RBR# V- ' www.newportbeachca.gov 1 (949) 644-3200 C-1-NO:F " Application for Report of Residential Building Record§�tO,.,t,� Application Fee: - $194.00 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: Fa Address: 1 if 4/I sr-S,�- City: Newport Beach State: CA Zip:F4 y663 /W //0— / 7!l 0^ Zip Code: FYI.ldq Owner Address: V76 City: � AjQ State: CA .. Zip Code: I z,./ ag Home Phone: Owner's Authorized Agent: I m Fc `vt ' /' Work Phone: Agent Address: I eP.g77�-vG4ejj- .5;-'. City: ,5Z4rv,�/r U State: Zip Code:9a )o ; Agent Email Address: Escrow Company: I C�%i Gni-t/.G LT/p'r&— esCl"©a) Escrow #:I. 73721 00 ,0 14,Q Escrow Address: %t/-7 1,a,>.2- City: GGL cTO��GI _ State: /ZiipCode:92,U3'7. Escrow Pho e Email Report to: /3%/tl 7 I—e4t- i'y. �.. je7nq;to r^ For Inspection call (Name): A /Q Direct Phone: /r I authorize inspections and re -inspections of the property listed above. I understand that if Building or Zoning violations are discovered I wil I be responsible to correct said violations. Owner/Agent's signature to authorize inspection: Date: OR Owner/Agent's signature decline' spection:� Date: Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH Buildin,Di A.e \Forms\RBR_7-30-20