HomeMy WebLinkAboutR2020-0548 - Permit ApplicationDocuSign Envelope ID: 89B4B91E-5F7E-4475-849A-9791A0925F9C
Print Form '
City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 ( Newport Beach, CA 92658-8915
RBR#P5L4 6 www.newportbeachca.gov (949) 644-3200
Application for Report of Residential Building Records
Application Fee: - $191.00 Notice:
(For AIIResidential 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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Address.
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PropertyOwner.
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Zip Code: 4212 101)
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Owner Address 9-71P &Ajslde Cove, to(51
State: CA Zip Code: K17uipt>
City: I Newip",* pjGIAr�L
Home Phone:
Owner's Authorized Agent: I mlovelle, Work Phones 1 -114. 3
Agent Address: I 1bj-:1 c:ftWAW-+ Lobb City: SCIt idp,
State: I \14 i4c Zip Code; I OWI VCC Agent Email Address:
Escrow Company: CeKiVW FQ4e4w c: irw• -> _._ Escrow #: CCl: �'q e, =-AA_a J ' "J
Escrow Address: �-,�� alVl Sr raS City:}jfq „..J"IC.RCy1
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State:) �A- Zip Code:41j.(oi.g Escro
Email Report to: �.�' Q1,1>�1.J Cfyl DWgV�ot�• 0 �r • , 1 1-,
For Inspection call (Name): '(,,�(� FIA111 ) 0941 ytt Direct Phone: � 1:�! • � t 1 .�(jflj ,Q.I p
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
20
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Owner/Agent's signature to decline inspection: 0.��.U"All It �e - 17nielr ilDate: �/1�2020
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Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
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