HomeMy WebLinkAboutR2020-0821 - Permit ApplicationPrint Form City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
QUILDING DIVISION
RBR# Q..2� y� 100 Civic Center Drive P.O.p.Box 1788 1 I Newport Beach, CA 92658-8915
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www.new ortbeachca. ov 949 644-3200
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Application for Report of Residential Building RecOI931soF,, `�tn2
Application Fee: - $19'1:68' l�'�. u'C) Notice: ti 'Z/,
(For All Residential Buildings) Applications with insuffee pa ent
Reinspection Fee $129.00 - or incomplete will be returne BEF
Please type or print and complete all information
#ofUnits:CA Address: i1 1 �(�ilQ City: Newport Beach State: Zip:NdLw
Property Owner: - j39�& rq l UL
Owner Address:
State: CA
Owner's Authorized Agent:
Agent Address:
State:
Zip Code: F
VM
Zip Code: F
YTS
City:
City:
Agent Email Address:
Zip Code: g2w(t
Home Phone:
Work Phone:
Escrow Company: �WUTYA Escrow #: u�L�45-
Escrow Address: 1� �2tb Ne4brk CMACv V11'
City:
State: Fc 4 Zip Code: PIMJLc Escrow Phone: l.eL- q - A
Email Report to: IVIN lI Cl �tI 1 �� 7 V
For Inspection call (Name): I ( V i R -
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 I will be responsible to correct said violations.
Owner/Agent's signature to authorize inspection:
Date:
Owner/Agent's signature to decline inspection: (D Dater Z T -b
—A&L
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH