HomeMy WebLinkAboutR2020-0482 - Permit Application&ocl.T'uSignEnvelope ID: 57287858-D3CC-4A2F-BCB3-A75490B5B210
Frmt Fom :,v! City of Newport Beach t
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive P.O. Box 1768 1 Newport Beach, CA 9 58-89 —1 5
RBR#�� --O y� Z— www.newportbeachca.gov j (949) 644-3200
Application for Report of Residential Bui
Application: Fee: -$191.00 Not
(For A11Resii ntial Buildings} ARF
Reinspection Fee $129.00 or'u
Records
cations With insuffioi-
Please type or print and complete all information
vnea
V
#ofUnits:F Address: 7. City NewporiBeachu State: CA
Zip:
lJ fry _
Property0wnera } ' 1� Zip
-. 'C—ode:a�
Owner Address t .__. r b_ .Id-uN 1 j City; �y1 iYIN.
State: CA Zip Code: 2Z:j1 Horne Phone:I[� -
— — C_,.+c,
Owner's Authorized Agent: Work Phone:
Cinn 7'7 3—Y.e
Agent Address: —�Q l l i�` �1 City.
[?�
State: k Zip Code Agent Email Address:
Escrow Company: l (''I( C 3 Escrow #:
_10-0- :..... �.`-....._ — ' __.1 .'l SSS SSS
y� , --
Escrow Address:-�C City:
State: Zip Code. c� �l Escrow Phone
Email Report to:
For Inspection call (Name): Direct Phone:
laLitho
violatio
Owner/
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
rze inspections and re -inspections of the pro perty11sted abov
ns are discovered I wilt be responsible to correct said violation
Agent's signature to authorize inspection:
OR
t f f) ... 819n.d by:
9u➢djn _Uivb10n\Forms\P99_9 (a-18
Account # 01050504-521040 ...............:.Make checks payable to: C1TYOF NEWPORT BEAeH