HomeMy WebLinkAboutR2020-0904 - Permit ApplicationCity of Newport Beach ( nk' JNITY
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION 0C i 14 ZOZO
r�r� 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
RBR# tib ZO - 0104 www.newportbeachca.gov 1 (949) 644-3200 CITY OF:
Application for Report of Residential Building Record' -v.,,, g-tz
Application Fee: - $194.00 Notice:
(For AIIResidential Buildings) ; Applications with insufficient fee payment
Reinspection Fee $x129.00 " or incomplete will be returned
Please type or print and complete all information
# of Units: P-7 Address: 112 46th Street A&BI City: Newport Beach State: CA„)Zip: 82663
Property Owner: Anthony & Brenda Siragusa Zip Code: F�
Owner Address: City:
State: CA Zip Code: i4, ,,.Home,Phone '.i
Owner's Authorized Agent: '.... Work Phone:
Agent Address: '', City:
State: Zip Code: F Agent Email Address:
Escrow Company: Freedom Escrow Escrow #17054
Escrow Address: 1200 Newport Center Dr., Suite 180 City: Newer Beach
State: FET Zip Code: 92660 Escrow Phone: (949) 644-3 939
Email Report to: Fmafreedomescrow,mm
For Inspection call (Name): N/A Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
l authorize inspections and re -inspections of the property listed above. l understand that if Building or Zoning
violations are discovered r will be responsible to correct said violations.
Owner/Agent's signature to authorize inspection: Date:
OR
Owner/Agent's signature to decline inspection: ALI:t�til� lwRA+ A��Date: ��,�t(,Z�jyd
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Account # 01050504-521040 .................Make checks payable to: CITY OFNEWPORTBEACH
Builtling Division\Forms\RBR 7 -3B -2D