HomeMy WebLinkAboutR2021-0731 - PermitsPrint Form71 City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
�� V _h� 2 00 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658 8915
RBR# V J www.newportbeancca.gov 1 (949) 644-3200
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Application Fee: - $198.00 Notice:.
(For AIIResidential Buildings) Applications with insufficient fee payment
Reinspection Fee $131.00 or incomplete will be returned
Please type or print and complete all Information
# of Units: �� Address:17
�Ci,Q v ) t City: Newport Beach ' State.
CA Zip:-�,
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Property
Owner Address:
State: CA Zip Code: 2677
F Q Zip Code: / -s7 '.
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Home Phone: .
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Owner's Authorized Agent: Work Phone: _.
Agent Address: .��� L; . (.J ..i��(Il 61/ ..*✓ .. City:...�v�C"'e(// e11�� Cell-CJj� _
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..—!. e: 7 2. fjr Agent Email Address: Pr,�{C C?..2-Iti�k Cam_. � <'L `1✓ 1
Escrow Company: �� �_ _L f rddb/
Escrow #: 311 1- � -
Escrow Address: 6 a
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Zip Code:
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Escrow Phone: 1 k19-�fv--
Email Report to: I mkt e / k 66 jade eserecul, cello
For Inspection call (Name): CYi:.G�? ���,,� _ Direct Phone:
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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
violationsare ' coveredIwillberesponsibletocorrect said violations.
Ow er/Agent's sig ure to authorize inspection: - /�C`� Date:
O
OR
Owner/Agent's signature to decline inspection:
Date:
HAdingDivisian\Farms\RBR 7-1-21
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH