HomeMy WebLinkAboutR2020-0897 - Permit Applicationwa 'ftECEryF4
IBM City of Newport Beachco 4r
COMMUNITY DEVELOPMENT DEPARTMENT lfMNNrTV
BUILDING DIVISION oc% 2
" �D 100 Civic Center Drive I P.O. Box 1768 ( Newport Beach, CA 92658-8915® RfCQ
RaR#Ll0L ria 1� www-newportbeachca.gov J (949) 644-3200 �CFVFtOPSENT
Application for Report of Residential Building Re, O 0 PGS
Application Fee: - $194.00 Notice:
(For All Residential Buildings) Applications with insufficient fee payment
Reinspection Fee $129.00 or incomplete will be returned
Please type or print and complete all information
#of units: � Address: 5507 RlverAvenue City: Newport Beach State Zip: 92660,
.._' - _m..... _.. _.
Property owner. Lamar Western L.P. Zip code. 82660_____
owneraddress: 5507 River Avenue City:._1Vewporx_B ach___....___ .
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State: F Zip Code. 52660 Home Phone: 1970-390-9944
Owner's Authorized Agent: N/A For Sale by Owner j Work Phone:
Agent Address: City:
State: Zip Code. �-. E
Agent Email Address: i
Email Report to: I jason@bluewaterescrow.com
For Inspection call (Name): 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:
Owner/Agent's signature to decline inspection:
Account It 01050504-521040
RuiWirq`PV{... kF-.\R8R 7-30.20
Date:
Date: , Li .• ;.
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checks payable to: CITY OF NEWPORT BEACH