HomeMy WebLinkAboutR2020-0485 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
m isli ,rF,� �j 100 Civic Center Drive P.O. Box 1768 Newport Beach, CA 92658-8915
ABR# 2 www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
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: F7 Address: ' S �1 /���� City: Newport Beach State: CA Zlp:
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Property Owner: . pt — _(�in_ Zip Code: �—
Owner Address: fs �o, Vin 1-17•iI ^ City:
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State: E==Zip Code: 132W27
Home Phone:
Owner's Authorized Agent: f �_ _ ,e Work Phone: a�L
Agent
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State:LSaSJ.�I Zip Code: Agent Email Address: jm?/nl ii1fAYPA 'I-1�.1'/Yfl
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Escrow Company:- n ✓:}-I I I(j rD^Escrow #:
Escrow Address:13 J City:
State: i I y� i Zip Code: 7 / 0 Escrow -"Phone: (���
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Email Report to:
For Inspection call (Name): �.r-A16 I UWP'W Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOWI
I authorize inspections and re -inspections of the property listed above. I understand that if Building or Zoning
violations are discovered I will be responsibleto correct said violations.
Owner/Agent's signature to authorize inspection:
Date:
OR
Docusigned by.
Owner/Agent's signature to decline inspection: Date: 6/19/2020 I
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148406B4892407...
Account # 01050504-521040 .................Make checks payable to: CRY OF NEWPORT BEACH
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