HomeMy WebLinkAboutR2021-0406 - Permit Applicationt Irgm„E : City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
g BUILDING DIVISION
��4 L 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
+� 4� www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
Application Fee: - $191.00 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. 1 35 Tide Watch City: Newport Beach State: CA ,:Zip: 92657
PropertyOwner:
Emily Mehr.,,,,,
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Zip Code: G2.(S-1
Owner Address:
35 Tide watch
Direct Phone:
! City:
Newport Beach
State: CA,
-,_- Zip Code:
92657
Home Phone:
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Owner's Authorized
. Agent: %"n.CWork
Phone: Io I
Agent Address: \rw, or-4-7_C—c"rt..er— City_.—t-w P V..r._ +q _ CI --
State: Zip Code:4rAgent Email .. _..
Escrow Company: ,.----- Escrow #: O Q1--)
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Escrow Address: j�I—G W,. r�/� City: N �� /"�`!t 9�C4C
State: .,%�-„�,� Zip Cod�ea (�2/��,� ` �Y Escrow PhoneaJ(��r'll✓u
Email Report to: I
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For Inspection call (Name):
(� I�G
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/Agents signature to authorize inspection: Date:
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Owner/Agent's signature to decline inspection: Date; FTiT2021
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Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
Building Div1s1on\Forms\RBB_9-1B-1B