HomeMy WebLinkAboutR2020-0957 - Permit Application02,0
" � ii���� `; City of Newport Beach NOV 1 0
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION Cw(or
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CAP9E2658-89�r
RBR# —0qS-7 www.newportbeachca.gov 1 (949) 644-3200 Ur'cgT
Application for Report of Residential Building Records
Application Fee:-. $194.00 Noticed
(For All Residential Buildings) Rpplications with insufficient fee payment
Reinspection Fee $129.00 or incomplete will be returned
Please type or print and complete all information
# of Units: I '' Address:.. Q _ ti0�<Y Y�+ City: Newport.. Beach State CA - Zip: C�a6`ti
Property Owner... ic.rAh_ Zip Code
Owner Address: .2�2....-gllx{(i _ Z___ City: _N f& —
State: CA — Zip Code: Yb�u Home Phone:
Owner's Authorized Agent: I Work Phone: l
Agent Address: ! City:
State: F77777 Zip Code: F�-, Agent Email Address:
Escrow Company ii Ireejdyy3 CS ocdW Escrow#:
Escrow Address: (w NQ,y Cr4 ctfv(v, pf, l$o City:
State: CQ Zip Code: gaG6Q-_� Escrow Phone:
Email Report to ',mow �Yeedbllf�Q$( fOY% GUy^
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 l will be responsible to correct said violations'.
Owner/Agent's signature to authorize inspection: Date:—
OR
Owner/Agent's signature to decline inspection: 6 dl Date: TO
Account It 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
Buildln�Division\Farms\RBP 7-30-20