HomeMy WebLinkAboutR2020-0295 - Permit ApplicationGEIVED 6
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City of Newport Beach FVFLOP ENT
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COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION MAR 13 2020
00 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
RBR#117 L1 -07'V 07-1 www.newportbeachca.gov 1 (949)644-3200 C:ITYOF
Application for Report of Residential Building Reams T BEPcr
Aoolication Fee: - $191.00 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
# of Units: Address: i / f �I co—J�!); j City: Newport Beach State: CA .Zip:.. 7
Property Owner:. �G�- ,/�_� i-�S .. o 6 `,i/�L Zip Code: F
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Owner Address: City:
State: CA _ _ Zip Code:— Home Phone: _.
Owner's Authorized Agent:
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Agent Address: ( (.-. _vS ti C City
State:.__ �� '�,, Zip Code: I / :Z 7—Agent Email Address:
Work Phone: I qt -M', 5R`-i..,._S()o .-7_...
Escrow Company: _.;,orr-ef. EsG�./� I ,,,,. // ! Escrow #: Sl..�� (��'�,.. o5
Escrow Address: `�{ --e. , S . C.G1R-S�r 7W..l�W City: / _ G//.Le r�6,� ....
State: rC Zip Code:) �LG �/ Escrow Phone: r`? ` --?/ 3
Email Report to: /�n-,JIDc. 5 61 -r lel.-Q�S�fG' 'V a 601- oma
For Inspection call (Name): \ ,4 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:
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Owner/Agent's signature to decline inspection:
Date:
Date:
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Building Division\Farms\RBR 9-18-18