HomeMy WebLinkAboutR2020-0851 - Permit ApplicationPrint Form City of Newport Beach dE ckbSA
COMMUNITY DEVELOPMENT DEPARTMENT CSC-yw
BIALO1%D8
DIVISION
100 Civic Center Drive j F Box 1 id 81 Newport Beach, CA 92658-8915
RBR# {22C.2D-OBSI www.newportgg"�'goav�®(y_d8 444 2000 1�a�k
Application for Report of il�etl iditg Records hp GN
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Application Fee: - $194.00 z O `�<Op Notice:
(For AIIResidential Buildings) ��� moi V,34j; T q� l cations with insufficient fee payment
Reinspection Fee $129.00 FWpORT 13 or incomplete will be returned
Please type or print and corni)YAnAMpormation
# of Units: F_ Address: Sq oaof) VI S I C_ City: Newport Beach State: CA Zip: aw"O.0
Owner Address: 110' ( 3
State: CA
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Zip Code:10',
Zip Code: F
City: NtLA"(A �CGGrI
Home Phone: gL�el.LJ- �a ye}
Owner's Authorized Agent: �— Work Phone: F
Agent Address City:
State: �', Zip Code: I Agent Email Address:
Escrow Company: t uiAQd5 F -SC Y!")' � Escrow #: 59 315-7 -a�.
Escrow Address: a%fl WOA3?o(� eertt�ry �:C a�('Jp City: (Ji„tJ0a ea J,
State: C�(j ZipCoide_: 010�(/�0(�!' "Escrow Phone: �yq�-719-113
Email Report to: 6�oxeVO-qA „ KaJI,nuSeScr0Q ,COM /
For Inspection call (Name): CLC ” �Wl Vtk.4t" Direct Phone: 94 o(A aaH a
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:
Owner/Agent's signature to decline inspection:
Buildin�DiNsion\Posms\RBR 7-30.20
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Date: I
Date: 110 /.ap
Account #01050504-5Z10M.... _...._.Makechecks payable to. CnVGF1 EKAP0RTBE4CH