HomeMy WebLinkAboutR2020-0930 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT VOEIVkb dkH
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA 92658-89%MMUNITY
RBR# 93f) www.newportbeachca.gov (949) 644-3200 NOV 0 2 REC'D
Application for Report of Residential Building Records
Application Fee: -$194.00 Notice: LO
(For All Residential Buildings) Applications with insufficidfitfee'rpayment
Reinspection Fee $129.00 or incomplete will be returned
Please type or print and complete all information
# of Units: 7 Address: ���� +✓jdLp P� ' / City: Newport Beach State: CA Zip:
�7 �1
Property Owner: l V VIAS' V 6r %yam Zip Code: C/ ems?
Owner Address: z�&d 1 - Z� City: .. /V (J��/J�fJ� cc _
State: CA Zip Code: Home Phone: F
Owner's Authorized Agent: 1—F '�)l4
Fl�V)l4 kf �S T j) ` Work Phone: C1W 1
Agent Address: City:
State: Zip Code: 9Agent Email Address:>�
Escrow Company: e/�J� c1711ro���Go Escrow #: 3 � 3 9
Escrow Address: A2? /2'61)-. csSV City:
State: �— Zip Code: Escrow Phone:
Email Report to:
For Inspection call (Name):
6rvevfif 6Z19�� �OY1ll_
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 orZoning
violations are discovered twill be responsible to correct said violations.
Owner/Agent's signature to authorize inspection:
Owner/Agent's signature to decline inspection: "Ld6/2/6�
BuildinEDlvision\Farms\RBR_7-30-20
Date:
Date: /l/-a,� -202.6
Account # 01050504-521040 ................. Make checks payable to: CITY OF NEWPORT BEACH