HomeMy WebLinkAboutR2020-0857 - Permit ApplicationPrint Form City of Newport Beach s 00,
COMMUNITY DEVELOPMENT DEPARTMENT le
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BUILDING DIVISION -n
rr,, ry 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA9i58-15
RBR# Zo U� OS1 www.newportbeachca.gov1 (949)644-3200 O R`2A
Application for Report of Residential Building RecordseEACH
Application Fee: - $41841.96, 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
of Units:FT� Address: �� 1 ��� ' City: Newport Beach State: CA 'Zipa v"Q-tD
PropertyOwner:r----
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Owner Address: I City:
State: CA Zip Code: Home Phone:
Owner's Authorized Agent:�n)/����(y j Work Phone: Gl
Agent Address: City:
State:
Zip Code: F Agent Email Address:
Escrow Company: I j co GSE ( Escrow #: f\�0�,2 -TF1
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Escrow Address: lZW NP `'v` �Y (� City: p ��'v IrAQy(�;�(/�
State: �' .q. Zip Code: �Z(.,Q(,Qo
Escrow Phone: 1 01 q(i- ULIQ -31- 51
Email Report to:
For Inspection call (Name): NI 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:
ORtj I �
Owner/Agent's signature to decline inspection: — d" Date: j %✓ )VtO
Account # 01050504-521040 .................Make checks payable to: CITYOF NEWPORT BEACH