HomeMy WebLinkAboutR2020-0827 - Permit ApplicationPrint Form City of Newport Beach scECEio�
COMMUNITY DEVELOPMENT DEPARTMENT OOM
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-52g
RBR# VOW - 6821 www.newportbeachca.gov 1 (949) 644-3200 RFCn
O;4 Dj Vvj O
Application for Report of Residential Building ReCONS MEN -
Application Fee: - $194.00 Notice: 4VPORT @SP
(For All Residential Buildings) Applications with insufficient fee payment
Reinspection Fee $129.00 or incomplete will be returned
Please type or print and complete all information
# of Units: F Address: 1p arnbrc s�nACitv: New oBeachState:State: CA zipq---,� Lo -o
_.
Property Owner:.f' \cL6V�n �•"4y.K-•f_y 2At� Zip Code: 52UUD
Owner Address:Cpm'pYidgL�`1�Q City:
State: CAI Zip Zip Code. 9'Zt_QI.cD.!, Home Phone:
Work Phone:
Owner's Authorized Agent: -��
r roc r anr�¢ f�lc}k�\ n
Agent Address: o 1�\Aw�7arh-G�..n-f1\—'� City:l\p�or�r-
State: �'�, Zip Code: q-7tcto i Agent Email Address: r` -o-6 a..r�nc...li\c�\ p,11\pp, Layn '..
Escrow Company: �JL.C�tOM �SC'COIrJ Escrow #: USy 63\
Escrow Address: Ia.c OrA-ce"4trl` )�I city:
State:) Zip Code: r�-yt,Q�i Escrow Phone: CLl� (jl.(y_3:j76C
Email Report to: I b P OD -FTRR Aom.$Ls Cr -oma. co 1-n
For Inspection call (Name): Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
I authorize inspections and re -inspections ofthe 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: �A
Arrnunt#01050604-571040 _..___._Mnkv rharkc nnvnhle tn: CITY OF NEWPORTBEACH
Building_Division\Forms\RRR 730-20