HomeMy WebLinkAboutR2020-0936 - Permit Application'ACEIVED @y
Print Form City of Newport Beach COMMUNITY
COMMUNITY DEVELOPMENT DEPARTMENT DEVELOPMENT
BUILDING DIVISION tt�
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92( 818;1%2020
RBRiIY//V �•��'� www.newportbeachca.gov 1 (949) 644-3200
CITY OF
Application for Report of Residential Building Rei rds
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'Application Fee: - $194.00 Notice:
(For All Residential Buildings) Applications with insufficient fee payment
Reinspection Fee $129.00 or incomplete will be returned
Please type or print and complete all information
'i y. Newport B _. State CA :Zi
#of Units:Ti Address: __ 4 Cit New ort Beach �' p: Ili
Property
Owner Ac
State:I
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g Work Phone:
Owner's Authorized Agent: _ �..�. Ir%t/ /(;
Agent Address: I !✓(,V�/ IItLL�II L-> 'I City: V
State:t 1Aj� Zip Code: FiU Agent Email Address:IA
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Escrow Company: C c ESC" Escrow #: 60/IF
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Escrow Address: G/ (�� `�( City: _
State: F Zip Code: rr � //��I��/," �A��//��' %///�� Escrow Phone: S
Email Report to: ri'�j PL
For
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For Inspection call (Name): t' -� �_• _ _._. 'I Direct Phone: - [ ��y2
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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: Date:
OR
Owner/Agent's signature to decline inspection:
BUIIdin�Oivision\Farms\RBR_7-30-20
Date:
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH