HomeMy WebLinkAboutR2020-0293 - Permit ApplicationDocuSlgn Envelope ID: 55C7EA86-A13F-4D6C-9588-190524D70817
��mrrn,�, City of Newport Beach-� aurrY
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COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION I✓Wtt' 3 20Zo
�(�%�100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA92658-8915
RBR# U�J" -"1 �> www.newportbeachca.gov 1 (949) 644-3200 CITYOp
Application Fee: - $191.00
(ForAllResidential Buildings)
Reinspection Fee $129.00
#of Units: 17 Address
Property Owner:
Owner Address:
State: CA (((----
ication for Report of Residential Building
Notice:
Applications with Insufficient fee payment
or incomplete will be returned
Please type or print and complete all information
City: Newport Beach State: El Zip: �
Home Phone:
Owner's Authorized Agent:% \) (� �� Work Phone:
Agent Address: 3 tv�l City: I
State: Zip Code: l,,..frc4i-y-4l/_-I Agent Email Address:
Escrow Company: 4f Escrow #:
Escrow Address:
city:
State: I ( f -t' Zip Code: (���� Escrow Phone: - �'(.-
Email Report to:
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 I will be responsible to correct said violations.
Owner/Agent's signature to authorize inspection;
Date:
OR
DocuBiend by: D..uft..d by-
Owner/Agent's
y:
Owner/Agent'ssignaturetodecline Inspection: : �� n ate: 3/13/2020
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Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
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