HomeMy WebLinkAboutR2021-0211 - Permit Application;o77�7rcn .J City of Newport Beach COMMUNIi
COMMUNITY DEVELOPMENT DEPARTMENT 71_ dELUPI1, ej\''
BUILDING DIVISION MAR 2 2 2021
q pg 100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA 92658-8915
RBR# Vq6-fl,9 I www.newportbeachoa.gov (949)644-3200 calor=.
Application for Report of Residential Building Recor"d(SPORT BEP'C"`'
ApplicationFee: -$194.00 - Notice:
(For AIIResidential Buildings) Applications with insufficientpayment
Reinspection Fee $129.00 or incomplete will be returned
Please type or print and complete all information
#of Units: �; Address: City: Newport Beach State: CA IZip:'
_129 26t.h._.�treet .-----_— _-- -__-- .__.. _.9.2-6.6.3_
Property Owner. Carl F Thon Zip Code: 82625
Owner Address - ^.-City:
2800 Ocn Lane
_,Newport--Beaeh-------_._._
ea
State: i Zip Code 92625_ Home Phone:
Owner's Authorized Agent: Work Phone:
Agent Address: City:
__.4 --Corporate .Elaza,----#-1.00.-- y-N-ewport_._Reach.,_-CA_.9-2560_.__-_-.___i
State: P Zi Code:L-9-2-6
92� Agent Email Address:
-- - --- ._&e.azt.@S-ea-n-+?a.rne,_com _.---------.
Escrow Company: Escrow #:
_Escso�a__`z'ecklzxal_c�g�.es_____._ N21 _0041..0=TE
Escrow Address: 5.0.0-9_..Bir_oh S.t_::.,_._Suet .3.400_-___-, City:
1`Iewpert__Beach___. __
State. FCa Zip Code: 92660 Escrow Phone: 949 945-2914
Email Report to: Terri@escrowtech.net
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.
Own er/Agent's signature to authorize inspection:
Date:
Owner/Agent's signature to decline inspection: L -)%--i__ Date:1��
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Accounts U1usu5U4-5Z1U44U .................Make checks payable to: CITY OF NEWPORT BEACH
Building Division\Forms\NBR 7.30.20