HomeMy WebLinkAboutR2020-0553 - Permit Application° City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION eurlveD ey
100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA9265UNITY
i.) _VEI_OPMENT
RBR# ��AZ-L7 � 0-63 www.newportbeachca.gov � (949) 644-3200
JUL. 0 7 2020
Application for Report of Residential Building Records
Application Fee: -$141.00, � ` 'Ntitrce:. � �� � �. CITY OF
(For.AllResidential Buildings
) App[icationswithficienlip
ayment
Relinspection Fee $129.00 or incomplete will'be r%Tned
Please type or print and complete all information
# of Units: Address: 119 39th Street — City: Newport Beach_ State: CA ':.....Zip: 92663
Property Owner: William and Julianne Ebeling Zip Code:
Owner Address: City:
State: CA Zip Code: Home Phone:
Owner's Authorized Agent: Work Phone:
Agent Address: City:
State: Zip Code: C Agent Email Address:
Escrow Company: Freedom Escrow Escrow #: 053803 -MM
Escrow Address: 1200 Newport Center Dr., Suite 180 City: I Newport Beach
State: FA J Zip Code: 92660 Escrow Phone: (949) 644-3939
Email Report to: mm@freedomescrow.com
For Inspection call (Name): N/q 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: Date:
OR
Owner/Agent's signature to decline inspection:'fy�–Date: p', ��. 7
o2p�
Account # 01050504-521040 ................. Make checks payable to: CITY OFNEWPORTBEACH
Budding_Vivision\Forms\RBR_9-18-18