HomeMy WebLinkAboutR2021-0449 - Permit Application:®Prin 7'IL1= _° City of Newport Beach COMMUNITY .� . -
COMMUNITY DEVELOPMENT DEPARTMENT DFVEL0PMEN1
BUILDING DIVISION
�%�/l /� 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA926449157 2021
RBR# I" (/ �� i www.newportbeachca.gov 1 (949) 644-3200
CITYOF
Application for Report of Residential Building RecoCrdsl�
t4�T a�
Application Fee: -$194.00 - _Notice:
(For All Residential Buildings) Applications with insufficient fee payment
Reinspection Fee $129.00 or incomplete will: be returned
# of Units: 1 571 Address:
Please type or print and complete all information
City: Newport Beach State: CA '',.,Zip: 9pQ.6,
Property Owner: M4V-(,iLs �iLe� Zip Code: iZs-7
Owner Address:_2_�2. SP-nGly. COVE, City: fiat o- ee4t 1 i
State: CA Zip Code: %�s-? Home Phone:
Escrow Company:�)(S7 Q(.�Ga(I 141"Panc/ Escrow #:
Escrow Address 47fi(&4 A'2.eej'can W.Al City. S0n-47 Gnel
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State: EF Zip Code: i;-io- ] Esc ow Phone: 'f 25D - yCZL
Email Report to: I 81 �J%� Z _�T 2[ >G1 m ' U%(✓1
For Inspection call (Name): Direct Phone: J�l 15o-Yvt)Y
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 l will be responsible to correct said violations.
Owner/Agent's signature to authorize inspection: Date:
OR
Owner/Agent's signature to decline inspection: ( G11�Q�l//�.. Date:
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
Building_Division\Farms\RBR 7-30-20