HomeMy WebLinkAboutR2020-0343 - Permit ApplicationPrint Form City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
�f�f�%/� 100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA 92658-8915
RBR# T~ r "`+'0 www.newportbeachca.gov (949) 644-3200
A plication for Report of Residential Building Records
Application Fee: -$191.00 . Notice:
(For All Residential uildings) Applications with insufficient fee payment
Reinspection Fee $129.00 or incomplete will be returned
Please type or print and complete all information
# of Units:Address: rD �1' �� �Q�4 11 t F I City: Newport Beach State: CA IZip.Gj a LE to
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PropertyOwner. uc\&,v r 6 Zip Code:
Owner Address: \rj \��lk `1st \� City: —77,
State: CA. _ Zip Code. F2 -1-e 1k �j j Home Phone:
Owner's Authorized Agent: I ;j d_ Cx-,,u�p� jk`I
Agent Address: d\ U La L� 1 R_ �C�iV _ 1
Work Phone:
City:
State: (�t� Zip Code: C) 3 Agent Email Address:
Escrow Company: I Cc— a
Escrow Address: 1731311:11
State: ��� {� Zip Code: C)—j-1,t t -e t�J.1
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Escrow #:
City: o,t, bFcy--j-
Escrow Phone: q90, - LPL( L4 _ 391 �Yr-1 i
Email Report to:F`Jco A- �Vo 0yv-1
For Inspection call (Name):'.... Direct Phone: '..
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 I will be responsible to correct said violations.
Owner/Agent's signature to authorize inspection:
Owner/Agent's signatureto decline inspection:
Building D1vision\Forms\RBR_9-18-18
Date:
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Arrount # 01050504-521040-----------------Mnkp rhprks nnvnhlp tiir OTV OF NFWPORT RFArH