HomeMy WebLinkAboutR2020-0476 - Permit ApplicationDocuSign Envelope ID: D365142F-1B9E4DDF-A852-66202919C5E1
City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
"?rSCEIVED a
COMMUNITY
DEVELOPMEN7-
.AIN 1 8 2020
BUILDING DIVISION
!i 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-891�ITY of
RBR# K' J'� Y_� I www.newportbeachca.gov 1 (949) 644-3200
G �!Ivpnor REP'e'
Application for Report of Residential Building Records
Application Feer- $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
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#of Units:171 Address: se(k v V1- City: Newport Beach State: CA Zip: vV
Property Owner:j(�_ _ ��1 Zip Code: �7
Owner Address: �L.. eQ L (1-t/,-� ( City:
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State: CA Zip Code: Home Phone:
Owner's Authorized Agent: —�� Work Phone:
Agent Address:
State: I —Ziptode: Agent Email Address:
Escrow Company: , S Escrow #:
Escrow Address: I City:
State: C ( Zip Cade: Escrow Phone: .J_1_L_ J GV -�(l (. —r
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:
Owner/Agent's signature to decline inspection:
OR
Doouftn� M"
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Date:
Date: ' /17/2020_.._". ____
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
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