HomeMy WebLinkAboutR2022-0290 - Permits,ECEIVED 61,
COMMUNITY
Print`Fom City of Newport Beach DEVELOPMENT
COMMUNITY DEVELOPMENT DEPARTMENT JUN 15 2022
BUILDING DIVISION
Z 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
RBR# www.newportbeachca.gov 1 (949) 644-3200 CITY OF
'PORT SS"
Application for Report of Residential Building Records
Application Fee: - $198.00 Notice:
(For All Residential Buildings) Applications with insufficient fee payment
Reinspection Fee $131.00 or incomplete will be returned
Please type or print and complete all information
#of Units: Address: i �t . or kr �, City: NewportBeachJ State: CA !Zip
PropertyOwnerckr�,�� (-vG _ Zip Code: 1vC)'
Owner Address: City:
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State: - - - - ---
CA !. Zip Code: 0 )210(0 O Home Phone >,'-Au -L5 -20y`
Owner's Authorized Agent: /� . N,q _ -I
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Agent Address-. 1� �d._ S i�� �i
Work Phone: ��.�-(•i('L__5��2
City: I_ N c'^^' �� jCA 61�-
State:I - Zip Code: g2(obU Sv -Vurq py-o'e-T� e5 Gor'v�
Agent Email Address: C any
Escrow Company: L&,AA Wed TM-e- j Escrow#: -1 i g 'S��'L '..
Escrow Address:-_L-((��o__�QA,3fV(k Uck. P'��J2..)' City: opJ?a✓+ C4C,
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State:I l/-fC Zip Code 17,lO1,O Escrow Phone: F'-91 i'2`1 3j�js
Email Report to: I akia Y--P�l/1 , ii 1,t.Y�.l�. L,j c I 1 �... • C�
For Inspection call (Name): Direct Phone:',
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
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 1!5`ktAjtQe i spection:
DECLINED
Owner/Agent's signature to decline inspection:
Date:I
OR Date: // b--'. i2-
9
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH