HomeMy WebLinkAboutR2020-0330 - Permit Application5ti�1FSIVk7j�, J
Print Form City of Newport Beach OMMUNITY')
COMMUNITY DEVELOPMENT DEPARTMENT'E-VF1,0PNtENr
BUILDING DIVISION �pppp ?p�
100 Civic Center Drive P.O. Box 1768 1 Newport Beach, CA92668-8915
RBR# (�C9 L0 0 >SC) www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Reca110!
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Application 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: '� $IYaYI,�Llts6 ! City: Newport State: CA Zip: �tZGrv7
PropertyOwner: Welua S(d-EN Lr $t4 , Zip Code:
Owner Address: City: tjewetT) r LDAST
State: Zip Code: of 2057 Home Phone:
Owner's Authorized Agent: �'j-�iv'�_ S' 1, Work Phone: gVgr Iq 2, & 5q j^
Agent Address: I 11so F-. &A eT Rw City: f.D"1�Nr���� motih4
State: (� 4 Zip Code: G � r
I —, 1%.��! Agent Email Address: S-(evFN @ Vft(40C. cam
Escrow Company: I ArmmcAy,)
Escrow M 1 (a ZD 638
Escrow Address: 1432190 Vie- 501-rG 2 o II City: 5Aw D(6; 0
State: I � Zip Code: ZIZZ Escrow Phone: q) o, 1,56
Email Report to: rJ (--0l-ON f�lC/, fA"
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For Inspection call (Name): NO .I �S Ve(--Q0 N 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 l will be responsi ble to correct said violations.
Owner/Agent's signature to authorize inspection:
Owner/Agent's signature to decline inspection:
Date:
Date:
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
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