HomeMy WebLinkAboutR2020-0964 - Permit ApplicationCity of Newport Beach 'kCEIVED el.
COMMUNITY
COMMUNITY DEVELOPMENT DEPARTMENT uEVELOPMENi'
BUILDING DIVISION
�
►Q �I 100 Civic Center Drive I P.O. Box 1768 Newport Beach, CAS265849OV51 d 2020
RBR#T V" �"O` r www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records CITY OF
.. - PORT BSA
Aoolication Fee:: -$191.00Notice:;
_ (For AlIlResideritial.Buildings) Applicatiormwithinsuffclentfeepayment:
Reinspection Fee: $.129:00: or Intomplete will. be: returned.
Please type or print and complete all information
#of Units: Address; M1 ?Cbb`(L `v�I City; Newport Beach State: CA Zip:
Property Owner: Rja�x /a Mv �S \Q Zip Code:.L(( Z
Owner Address: TJ I (0 p �� p5( N� I City: (X\MCAV
State: Zip Code: I "t y�t4_ - Home Phoned Z114 01 '1,, L-0 fo LO
C�l0vi wls ��
Owner's Authorized Agent: `Z Work Phone: ��� G
Agent Address: N vcity: a oc* g zkLh
State: Zip Code: Agent Email Address: • (�ne1� ��(,��t,�,�G
FA I 1901 Fit, TAINA E rIN 7f.0,.:A 01
A M10 QMV My
Email Report to:
For Inspection call (Name): Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
iauthorize inspectionsand,re4nspections afthe property listed above. I understand,that.ff Bu.ildingorZoning.
violations are.discovered'I will be:responsibl'e.to correctsa:id violations.
Owner/Agents signature to authorize Inspection:
Date:.�I
OR
Owner/Agent's signature to decline inspection: Date:.'
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
Bullding-Bb11onNft >u RR_9 2&U