HomeMy WebLinkAboutR2020-0310 - Permit Application.-....w.,�y�..uvmvyc ,v, wvaewv-l.wli-4uUD-tlG61'-CUHtt9 /`J I-1 rU
6'MCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
n 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
RBR# 1-ZO?X- 0 1'0 www.newportbeachca,gov 1 (949) 644-3200
Application for Report of Residential Building Rernr•ric
Application Fee: - $191.00 Notice:
(For AIIResidential Buildings) Applications with insufficient fee payment
Reinspection Fee $129.00 or Incomplete will be returned
Please type or print and complete all information
I
# of Units: Address: 1 612 Hi 1 vanar JI Cit New ort Beach State: CA Zi 92660-4028
City:
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PropertyOwner•IPopeye No 1 LLC -4028
Zip Code: 92660
1
Owner Address: 612 Hilvanar City: Newport Beach
State: CA Zip Code: 92660-40281 Home Phone 626-864-4060
Owner's Authorized Agent: Ben Lefrancoi s Work Phone: 4-7- 938
Agent Address: 19440 Goldenwest Street City: Huntington Beach
State: CA Zip Code: 92648 1W lull[e groat I.cum
Agent Email Address:
Escrow Company: Central Escrow Group, Inc Escrow#; CEG904510-HJ
Escrow Address: 2134 Main Street #185 City: Huntington Beach
i
State: CA Zip Code: 92648 Escrow Phone: 714-698-9982X104
Email Report to: heidi.james@centralescrowgroup.com
For Inspection call (Name) I Heidi James I Direct Phone: 714-698-9982X104
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
DocuSlSned by:
Owner/Agent's signatureto decline inspection: I Date: 3/25/2020 l 2:49 F
DDB F98AE050E484...
—w W r l • ^ v�vJvOvl-�'+w`U ,,,,,,,,,,,,,,,,,macre cnecrcs payable to: CITY OF NEWPORT BEACH
Bull dIng DlvIslon\Forms\RBR 9.18. 18