HomeMy WebLinkAboutR2021-0239 - Permit Applicationi
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Print Form City of Newport Beach COMMUNITY
I�)EVELOPMENT
COMMUNITY DEVELOPMENT DEPARTMENT °
BUILDING DIVISION MAR 31 1.021
��621^�n pia 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
RBR# rL L www.newportbeachca.gov 1 (949) 644-3200 �;ly { OC.
Application for Report of Residential Building Recordk
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:F Address: 20 TASMAN SEA City: NewportBeach State: CA Zip: A?-6s7j.
Property Owner.Dt71Co:Vltolo ZNAtJ(q Slri&K-b Ya)U(:p Zip Code:L S
Owner Address: ZD"CASMAM SEA city: metapoEr cots -r
State: CA Zip Code: z6SHome Phone: /fq -ZZ 0 -311-L
Owner's Authorized Agent: 'b AV L(, ��N Work Phone: IqLf q -Zqs_ Z S
Agent Address: 37- CpWM SL)S City: (('LVLN
State: (' A Zip Code:Fol7 26 Agent Email Address: v,d,N2(cs YA Wda CSM
Escrow Company: 105 11310L C -SC -bv)
Escrow #:
-CM
Escrow Address: I (dJ CORPOATE p001.14. # L B 5� City: I ` R V LN E /y 4 p.
Stater Zip Code: Q.y606 Escrow Phone: R�.y ,_'3S -j-
Email Reportto: MW(I.C.14Z C`ENTaaL�Sc s"LJGr�eup.COM I
For Inspection call (Name): I A pv t % ?-Q N Direct Phone: �R -Z 5 -,?z S9
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
Owner/Agent's signature to decline inspection: Date: 3 —36-20ZI:
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
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