HomeMy WebLinkAboutR2020-0923 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT J
BUILDING DIVISION
pn (Qn 2 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
RBR# www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
Application Fee. $294.'66,, Notice:
(For°All gesidentiai Buiid ngs}", Applications with iosuf6cient fee payment
Remsoe tiat,Fee $124a(U or incomplete will be returned
Please type or print and complete all information
State: [Newport CA Zip: �� 6
#of Units: � Address: (�� Pe.Cftf � A��r\ City: Beach I,
Property Owner. �0.�^"QS (Z-- Q,)C,,j-1 _ Zip Code: q�6b-�..
Owner Address: }(Q QYU.�ri AVQ,v�V-e, City: I NJ",) r4 QQlnlrl-, :...............
State:CA Zip Code: Gj�ZHome Phone:
Owner's Authorized Agent: Work Phone:
Agent Address: City:
State:F- Zip Code: F Agent Email Address:
Escrow Company V(-uJam [,,oc,r6 WEscrow #: �y 130 Tl^J
Escrow Address: 12.cD NY,w�lr�f-i Ck+�''<Ca pr. —��Q City: mecpGr l ��qt,✓r
State: 1,�� Zip Code: 0�,6�-y Escrow Phone: �l-{ j, 6�u.3i3�
Email Report to: �W Q. Vy-U4M ZSLfOVA- CL"^r
For Inspection call (Name): Direct Phone: r
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 l will be responsible to correct saidviolations
Owner/Agent's signature to authorize inspection: Date:—
Owner/Agent's signature todedine inspection: Date j 0
Account # 01050504-521040 .................Make checks payable to: CITY OFNEWPORT BEACH
Bwlding_DIvlSinn\Forms\RBR 7-30-20