HomeMy WebLinkAboutR2021-0834 - Permit ApplicationPrint For City of Newport Beach !<
COMMUNITY DEVELOPMENT DEPARTMENT y "' ^
/1 BUILDING DIVISIONi-
h i is Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8815
RBR# www.newportbeachca.gov 1 (949) 644-3200
mpip(ication Tor Report of Residential Building Records
Aiap-! tion Fee: - $198.00 Notice:
(For All Residential 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: /� p `' - Y I Ci I I
60 S k V 'O^'i 9 1 ty: Newport Beach State: [CA Zip:FT)-- �jo
Property Owner. -
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Owner Address: I p �3�� (; ),�
State: CA Zip Code:
City: �Y' v✓��Y (Gh
Home Phone:
_ T4� 642 -2-Vc8
Owner's Authorized Agent: ��kV !Y\ \ni� Work Phone:
Agent Address: //p o r70 dk- siren V`� - fpy- p � City: 4�ewtrv,��
State: //////'''''' ((} Zip Code: `"� 1 - - - - - -
-C�-t�fJUU_ Agent Email Address: GIC�/U'\W ofnUl'�'e(�q'j`yvtt� CON
Escrow Company:
Escrow Address:
State: I _- C. (\.
4-6--6 I6)-_Yuncct
Zip Code: -1 L6 (1 w
'cl-y 'n City:
Escrow #: I 0 � I � �j Z -0
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Escrow Phone:
Email Report to: I We Ad1 � 6 0--- C'& S6 ra-W 14C
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For Inspection call (Name): Cekhr[A q ra y, Direct Phone: 014-q)Ab-�
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW) 1
I authorize inspections and re -inspections of the property listed above. I understand that if Building orZoning
violations are discovered I will be responsible to correct said violations.
Owner/Agent's signature to authorize inspection: Date: (�- (� ��
OR
Owner/Agent's signature to decline inspection:
Date:
Hccourn rr uiuououv-c[wau .................Make checks payable to: CITY OF NEWPORT BEACH
Wldln�M i .V.r.sXRBR 7-1-21