HomeMy WebLinkAboutR2021-0309 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
n��D2 oC 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
RBR# L J www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
Aoplicibn Fee: - $i94.0p Notice:
(For 1C� esidential Buildings)
Applications with insufficient feip"'payment„
� teinspet ion fee $129.00 or incomplete will be returned
Property Owner: L%jG{VVv ty
Owner Address: 3l)Q� W, OCAfA �r
State: CA Zip Code:Ft-;Z
Zip Code:
City:.-- N-��f`�� i.�•
Home Phone:
Owner's Authorized Agent: Work Phone:
Agent Address: City:
State: �— Zip Code: Agent Email Address:
Escrow Company: Flu dpy.,. �<,(,Yow„) EEs"crow#: 0sigsu
Escrow Address: ('�(� WUrj- �u.� 9Vi City:
v- I
State:C Zip Code: �'�, 6t, (J Escrow Phone: c(qq bL/ L/ 3 CI 3 C
Email Report to: 54 i Vj k6 R5L(0 , co, '
For Inspection call (Name): 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:
OR
l
Owner/Agent's signature to decline inspection: / Date: y-2 ,� J
Account # 01050504-521040 ................. Make checks payable to: CITY OFNEWPORT BEACH
Bui Idin�Divisinn\Farms\RDR 7-30-20
Please type or print and complete all information
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#ofUnits: I
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I Address:
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'�-y.Q�. yAq�
City:
Newport Beach....
Newport
State:
CA Zip:
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Property Owner: L%jG{VVv ty
Owner Address: 3l)Q� W, OCAfA �r
State: CA Zip Code:Ft-;Z
Zip Code:
City:.-- N-��f`�� i.�•
Home Phone:
Owner's Authorized Agent: Work Phone:
Agent Address: City:
State: �— Zip Code: Agent Email Address:
Escrow Company: Flu dpy.,. �<,(,Yow„) EEs"crow#: 0sigsu
Escrow Address: ('�(� WUrj- �u.� 9Vi City:
v- I
State:C Zip Code: �'�, 6t, (J Escrow Phone: c(qq bL/ L/ 3 CI 3 C
Email Report to: 54 i Vj k6 R5L(0 , co, '
For Inspection call (Name): 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:
OR
l
Owner/Agent's signature to decline inspection: / Date: y-2 ,� J
Account # 01050504-521040 ................. Make checks payable to: CITY OFNEWPORT BEACH
Bui Idin�Divisinn\Farms\RDR 7-30-20