HomeMy WebLinkAboutR2020-0527 - Permit ApplicationPrint Form
City of Newport Beach "=_lvev oy
OMMUNITY
COMMUNITY DEVELOPMENT DEPARTMENT u -VE OPNIENi
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-$'M 3 ® 2020
RBR# ��'�'210 05Zl% www.newportbeachca.gov (949) 644-3200
Application for Report of Residential Building Records `•'iTYOF
Application Fee: - $191.00 Notice:vI'OR7 13>~PG
(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
�v� W. 'fAc�C��t'i-O7\�' City: State: CA...IZip. q-�.�._�ii
# of Units: Address: Cit Newport Beach
PropertyOwner:
Zip Code: I
Owner Address: t Qdc:)I�c LJ " C7CA.C�`t�-Y��"' City:
State: CA Zip Code: C�'lo---i)
Home Phone:
Owner's Authorized Agent: Work Phone:
Agent Address: �t>2S. w-t-��Ce..-.\�l�.....II City:..
State: , Zip Code. cid-ite' Agent Email Address:�.�C.VVA-T,I` QScJc-Y,C,_l1,
Escrow Company: I
Escrow Address:
State: I Zip Code: F- ;u-'2,
Escrow #: I 3I-�
City: I �,y2Ax ��---\-'�
Email Report to:
Escrow Phone. 19LA _
For Inspection call (Name): I 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: F- i
OR
Owner/Agent's signature to decline inspection: �LS.1ir Date: UH&g -: 6 c�
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
Building Mlslon\Forms\RBR 9 18 18