HomeMy WebLinkAboutR2020-0289 - Permit ApplicationDocuSign Envelope ID: 2C8B7605-2260-4C85-855D-893EBBDF3A4D ,,y,OEIVED
FOO Cit of Newport Beach :uw�uwry
Y p E-VI=LOPMENT
COMMUNITY DEVELOPMENT DEPARTMENT j �.
BUILDING DIVISION 1 13 2020
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
RBR# 7�0(�)! o — o z-6 Gi, www.newportbeachca.gov 1 (949) 644-3200 <..I ry OF
Application for Report of Residential Building Record's'an„T 9,0011
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
#ofUnits: Address: aPIS/Y��� r�G City: Newport Beach State: OZip:
Property Owner: Y') 9( __ _Y1J.. Li --_- Zip Code: E
Owner Address: a ��/Iy�'!� r� (/ City: N -
State: CA Zip Code: l (s1Ai /� (/J Home Phone:
Owner's Authorized Agent: fj���L L.G� c II/',v_ Work Phone:
Agent Address: [_3ql B4tAffl _ eYi.V�C.-----1 City: -O5.. T---9.0 4.. .-----.—_---
State: _ Zip Coder Agent Email Address:
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Escrow Company: SL V _ —] Escrow
Escrow Address: T w_ F— v //,/ 2/,{' r City: //I j
State: F- " Zip Code: _ Escrow Phone:
Email Report to:
For Inspection call (Name): Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOWI
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/Agent's signature to authorize inspection:
Owner/Agent's signature to decline inspection:
Bull dM DWlsian\Farms\qeR 9-lbl8
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by:
Date:
Date: 3/12/2020
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH