HomeMy WebLinkAboutR2020-0881 - Permit ApplicationPrint Form City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
p we Center Drive P.O. Box 17681 Newport Beach, CA92658-8915
RBR#� W � www.newportbeachca.gov (949) 644-3200
Application for Report of Residential Building Records
Application Fee, $194.00
(For i l Buildings) Notice:
Reinspection Fee$129.00 Applications with Insufficient fee payment
or incomplete will be returned
Please type or Print and complete all information
#of Units: l E:- Address: ` P(J 1 Gq✓, GIY , City: Newport 0each. State: CA ;Zip: S')
rropertyuwnercl lVlgV1'ylQ il/ASCG'l�l[',.LG( -- -�-L'1J_.�QS��G/a.• Zip Code: 8265"1
Owner Address: ttt Pel'tah I�� el✓• city: I�ewPdVl- �i2aCl'►
State: l—_--- Zip Code: vl � Home Phone:
Owner'sAuthorized Agent: F, wYl � Work Phone: [4::15>1, 5 _-5z3 6
Agent Address: 4& �t/gV1w t b0 City: V\
State: _ G' Zip Code: l !/Ir/l&4- Agent Email Address:
Escrow Company: ICb YKev S -C, c,/6 U) Escrow#: LLo � L
Escrow Address: It 8-502-`
I VV I Vt,1y LL : U S I ✓'�
State:: C-• Zip Code:
• Escrow Phone:
Email Report to:
For Inspection cal
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: 0 Date:
OR
Owner/Agent's signature to decline inspection:
' Date:
^•��� •^..,,,��.,•.-��,vw�................. iwaKecnecsspayable to: CrryOFNEWPORTBEACH
o�name_om:ve�\romu\aeA �-w-�a