HomeMy WebLinkAboutR2020-0920 - Permit ApplicationPrint Form City of Newport Beach ', �i.�p,�i,ly;
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION ?02�
Q020 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92659IL&5°
RBR# Q020 - Op 20 www.newportbeachca.gov 1 (949) 644-3200
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Application for for Report of Residential Building
Application Fee: - $191:9e EC1y, L CS
(For All Residential Buildings)
Reinspection Fee $129.00
Notice:
Applications with insufficient fee payment
or incomplete will be returned
Please type or print and complete all information
#of Units:Fl- Address: S�irlinev�Sall� �UUYk S$ City: Newport Beach State: CA Zip: ZIJL�t J
Property Owner:
Owner Address: 1 t m I fl lY_ City: .���ii'�
State:
Zip
Home Phone:
Zip Code: F
C
Owner's Authorized Agent:
rnVIC v i c Work Phone:
Agent Address: City:
State: Zip Code: F Agent Email Address:
Escrow Company:fe b)� L-S`Ivoi-d Escrow #: D514647R
Escrow Address: �� Pb � l ity: NC( �/ y l
State:CA Zip Code: F=0 Escrow Phone:
Email Report to:
For Inspection call (Name):
eeCUM CyvM, CaYA
Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
I authorize inspections and re -inspections of the property listed above. I understandthat if Building or Zoning
violations are discovered I will be responsible to correct said violations.
Owner/Agent's signature to authorize inspection:
Date:
A'%R
Owner/Agent's signature to decline inspection: Date: lb 23
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH