HomeMy WebLinkAboutR2020-0875 - Permit Application.glint Form City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT ktVgtj
BUILDING DIVISION
n 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-891jvFi ` r'°'i
RBR# VC 2oZ� ' Oils www.newportbeachca.gov 1 (949) 644-3200 QCT () 6 ?020
Application for Report of Residential Building Records
,, 1 r OF
Application Fee: - $194.00 Notice:
(For AIIResidential Buildings) Applications with insufne e'owee 0*ent
Reinspection Fee $129.00 or incomplete will be returned
Please type or print and complete all information
# of Units: Address: �\� �P,CL���C City: Newport Beach State: CA Zip: �ab
Property Owner: —\,--)Or�\`,� --� ��� �' �(L\�� Zip Code: 7Z\;4C0
Owner Address: City: I '<�Q') U-"
State: CA Zip Code:�\8
Home Phone: I D�Ac�-\ 5�-
Owner's Authorized Agent: Work Phone:
Agent Address: C�0\00�v. u�\(�L,�Si.hS'-'\ S'�' city:
State:�Q� Zip Code: Agent Email Address: `
Escrow Company: Escrow Escrow #:
Escrow Address: 3c'�\� �,(J��j �y,�\I city:
State: Fu:� Zip Code: '�1��l Escrow Phone:
Email Report to:I ��Q����r�r��C����CyJ, C0�
For Inspection call (Name): �� �'�p�\,��_ 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 signature to decline
BuIIdin�Division\Farms\RBR_7-3420
Date:
Date:
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH