HomeMy WebLinkAboutR2020-0961 - Permit Application. r1^'I ur i �OEVVE'p ,q
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�I City Of Newport Beach COMMUNITY)
COMMUNITY DEVELOPMENT DEPARTMENT CI�VEI OPMEN11
BUILDING DIVISION pp���``II q 99pp99
1 (� q 100 Civic Center Drive P.O. Box 1768 Newport Beach, CA'9265 Id40
RBR# USI �� www.newportbeachca.gov 1 (949) 644-3200
CITY OF
Application for Report of Residential Building R cords
Application Fee: - $194.00 Notice:'
(For AllResidentialBuildings) . Applications with insufficient fee payment.
Please type or print and complete all information
#of Units: Address: 2.10 Gorv�p—{ A�fy\,U,c I City: Newport Beach State. CA Zip: g�
Property Owner: __ 0✓A0y% uS&v 606 ......_._L p Zip Code:
Owner Address: '�(� barytQ�.i evnl� -..._' City: Q�I�U� �S(C1Nli
State: CA - Zip Code ��y66 ti' Home Phone:
Owner's Authorized Agent: '�, Work Phone:
Agent Address: City:
State: F— Zip Code: Agent Email Address:
Escrow Company: f�e�dry-� G�L�ti,,� Escrow#:1Q�� !...
Escrow Address )�4D N2W(oart- C¢Ya4'Zr Of.4TO--_-.-.. City: NQwpm'+ t'L,
State: -._..CA Zip Code: I gY66 �... � Escrow Phone: I `4l l 61i4 3935
Email Report to: vJ t Y2e �dM`�Q,S(. icTr1 coiA,%
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 correct said violations
Owner/Agent'ssignaturetoauthorize inspection: : Date:
\ OR
Owner/Agent's signature to decline inspection: �I � n J Date: i i W-4
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
Building_Division\Forms\RBR 7-30-20