HomeMy WebLinkAboutR2020-0884 - Permit ApplicationPrint Form
City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA9526'31'81.691$5
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Application for Report of Residential Building Rec®Pd12020
Application Fee: -$-1-91-.ft iqq, o t% Notice: 01 f'Y of -
(For AlIRes Went! aI Buildings) ApplicationslW,i h insufficipPt fee payment
Reinspection Fee $129.00 or incomplete IW136 r�rned
Please type or print and complete all Information
# of Units: Fj:: Address: t�S IS City: Newport Beach State: CA Zip: X02—
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Property Owner]
Owner Address:
State: CA Zip
Owner's Authorized Agent:
Agent Address:
State:
Zip Code:
L
City:
Home Phone:
ly) Work Phone:
City:
Agent Email Address:
Zip Code: F
Escrow Company: `l r (.. �Y r l G Yn Escrow #:I��� J r
Escrow Address:1�O ASN W� VT
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State: Zip Code: I 'I z-UWD Escrow Phone: 1
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Email Report to:
For Inspection call (Name):
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0416W ' 001/�
j R Direct Phone: p li� 0
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:
R
Owner/Agent's signature to decline inspection
Date:
Date: 0
Account # 01050504-521040 .................Make checks payable to: CITYOF NEWPORT BEACH