HomeMy WebLinkAboutR2020-0287 - Permit ApplicationPrin–t Form City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT par'�IVEp 9y
BUILDING DIVISION COMMUNITY
100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA9NSWgfflT
RBR# CTO—Cp www•newportbeachca.gov (949) 644-3200 MAR 12 2020
Application for Report of Residential Building Records.,
Application Fee: - $191.00 Notice:N Gx\
(For AlIResidential Buildings) Applications with ip u"Ricient fee payment
Reinspection Fee $129.00 or incomplete will be returned
Please type or print and complete all information
# of Units: FA- Address: ,F Ya C{ Bina � City: Newport Beach ' State: CA Zip: g2cDl¢Z
PropertyOwner: M J 6 rnJi d $ I , Siff4 Zip Code:
Owner Address: ! City:
State: CA _ 1, Zip Code: �� Home Phone:
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Owner's Authorized Agent: 'f t� ./ams..... Work Phone:
Agent Address: `• City: l
State: F Zip Code: Agent Email Address:
EscrowCompany://1TVG Escrow# VJL`!f•.. _..
Escrow Address: 02 ck)fv4 ce4v 01(- City:_ 6vp Goiy)
State: I �" Zip Code �(.J
gwt'; Escrow Phone: � 9–Y0I / 301
Email Report to: V C'�1.�' C0111) _ _ f. wI V v.
For Inspection call (Name): N( w- ; Direct Phone: I N 0-c\
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: 7 Date: I I IzI 0% it)
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
Building Division\Farms\RBR 9-18-18