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HomeMy WebLinkAboutR2021-0265 - Permit ApplicationR FcC11Z 0 Print Form City of Newport Beach 9p� �o��L�°AY�� COMMUNITY DEVELOPMENT DEPARTMENT ; BUILDING DIVISION -c 100 Civic Center DriveI P.O. Box 1768 Newport Beach, CA9265&891�c° RBR# - �� ` ©ZL www.newportbeachca.gov I (949) 644-3200 �� T F— !'A'ORT BEAOm\ Application for Report of Residential Building Records Application Fee: - $194.00 Notice: (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: FA Address: a.E aO ��Gi'l�Y`,OV $, r� Ly� _. City: NewportBeach_ State: CA .!Zip: S -6 d -.S Property - %fit°D t`1 Owner Address: I. _ L -a' o L State: CA.... _... Zip Code. City: CUf 6"6) CLj Me, � Home Phone Zip Code:Ia-VJ--S.-_.. Owner's Authorized Agent: Work Phone: Agent Address: City: State: F7777 Zip Code: F Agent Email Address: L. Escrow Company: A.._.f JSC Y,'_.H „ _.i Escrow #: C?Sy S S 3 TI -0 j Escrow Address: Ig -EO f�wQo�t Qr�eO D'+._. l&�'...I State:C�\ Zip Code City: -.._._ Escrow Phone: I 9LIC-1 �qLy , 99 Email Report to: I TH/ f22A0p Q.SC.f O W Cpt) 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 l will be responsible to correctsaid violations. Owner/Agent's signature to authorize inspection: Date: OR p A p Owner/Agent's signature to decline inspection: 4011- Date. Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH Building_Division\Forms\RBR 7-30-20