HomeMy WebLinkAboutR2020-0490 - Permit Application,?y_CEIVCb 6y
City of Newport Beach COMMUNITY
COMMUNITY DEVELOPMENT DEPARTMENT 0FVrL0ProFN7
BUILDING DIVISION JUN 17 2020
. �1
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
RBR# �UU—M'1-p www.newportbeachca.gov 1 (949) 644-3200
CITY OFF
Application for Report of Residential Building Records 1
UBr >al:
AOPlication Fee: - $191.0o Notice:
(For All Residential Buildings) Applications with insufficient fee payment
Reinspection Fee $129.00 or incomplete will be returned
Please tvoe or Print and complete all information
#ofUnits: n Address: Q ((tj�i� City: Newport Beach State: FCA 'IZIY
Property Owner:-Am_,e 3_I_\)� -Zip Code: ��
Owner Address: _�— V r r Q. _ l _'`�-�_ City:
State: Zip Code: 9�, 0 Home Phone: 177
Owner's Authorized Agent: Work Phone:
Agent Add�ress�:. e� _ _ _ I. City: J
State: Zip Code: , I (I Agent Email Address: Q� f. v • 1
Escrow Company: VW Escrow #:
Escrow Address:
State: ITF
Email Report to:
J ,�
For Inspection call (Name):
Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOWI
I authorize inspections and re -inspections ofti1b property listed above. I understand that if Building or Zoning
violations are discovered I will be responsible to correct said vlolations.
Owner/Agent's signature to authorize inspection:
Owner/Agent's signature to decline inspection:
e�namdowmen\ramie\naa s-ve-te
Date:
OR
6/15/ZULU
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH