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HomeMy WebLinkAboutR2022-0157 - Permit Application4 1/6. C� 'r ., f i \ti.,eCEIVEO H)- City yCity of Newport Beach COMMUNITY COMMUNITY DEVELOPMENT DEPARTMENT DEVELOPMENT BUILDING DIVISION9 r 9 I�U/ZZ 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-144 022 RBR#_ www.newportbeachca.gov 1 (949) 644-3200 CITY Op Application for Report of Residential Building Re*#S Application FeeNotice (For AllResrdentral9 aldin s �'�'^' ppplicatrons wrtM,lnsufficient;fee payment RemspectionFee $131OOr op)hcontpietewrl bereturneq Property Owner: tp)'tetAGWc2/lCer4n4 C3arjara (/a r.Y r"er-s Zip Code: `12660 Owner Address: 1i RI°dqr�(ioe DY 77 City: �ecv xrt �ea.c<-�l Cfi State: CA Zip Code:P26L 6 Home Phone:,q-.31)Z25r-5`11/ Owner's Authorized Agent: Dan iei[e NG5/ey J Work Phone: yt(rl 2-64-7333 Agent Address: 0 )q ( S eA I.JYicyh'i D Y!V'e _ City: T� .Dana Porn t State: Zip Code: �Z6 Z9 Agent Email Address: olanihe5l��r�mgi/. Cu»'1 I Escrow Company: Escrow #: Escrow Address: City: State: Zip Code: C— Escrow Phone: __ J Email Report to: for Inspection call (Narr.e):J Direct Phone: —� -- --------------.J CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW) Account # 01050504-521040 .................Make checks payable to: CITYOF NEWPORT BEACH BAding 01vision\Farms\RBR 7-1-21 Please type or print and complete all information ' # of Units: © Address:,- City: Newport Beach State: CA Zip: Property Owner: tp)'tetAGWc2/lCer4n4 C3arjara (/a r.Y r"er-s Zip Code: `12660 Owner Address: 1i RI°dqr�(ioe DY 77 City: �ecv xrt �ea.c<-�l Cfi State: CA Zip Code:P26L 6 Home Phone:,q-.31)Z25r-5`11/ Owner's Authorized Agent: Dan iei[e NG5/ey J Work Phone: yt(rl 2-64-7333 Agent Address: 0 )q ( S eA I.JYicyh'i D Y!V'e _ City: T� .Dana Porn t State: Zip Code: �Z6 Z9 Agent Email Address: olanihe5l��r�mgi/. Cu»'1 I Escrow Company: Escrow #: Escrow Address: City: State: Zip Code: C— Escrow Phone: __ J Email Report to: for Inspection call (Narr.e):J Direct Phone: —� -- --------------.J CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW) Account # 01050504-521040 .................Make checks payable to: CITYOF NEWPORT BEACH BAding 01vision\Farms\RBR 7-1-21