HomeMy WebLinkAboutR2020-0967 - Permit Applicationr
RBR#
Novi 12020
Application for Report of Residential Building Records
City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT iypo �y
,;OMMUNITY
CA9265,$=R'Ao MENl
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 Newport Beach,
www.newportbeachca.gov (949) 644-3200
Application Fee; -4194.00 Notice: C ITYOF'
(For AR ResrclentiahRuildings)Applications with in��tb4lyment
Reinspection"Fee $129.00 or incomplete will be returned
Please type or print and complete all information
# of Units: IT, Address: 123E Balboa Blvd. — City: Newport Beach State CA ,Zip: 92661
Property Owner: Irving Feldkamp '.� Zip Code:
Owner Address: ( City: I...
State: CA Zip Code Home Phone State: F-7-,
Owner's Authorized Agent: Work Phone:
Agent Address: I.., City:
State: F Zip Code: Agent Email Address:
Escrow Company: I Freedom Escrow Escrow #: 054186 -MM
Escrow Address: 11200 Newport Center Dr., Suite 180 City: L Newport Beach
State: FCA Zip Code: 92660 Escrow Phone: 1 (949) 644-3939
Email Report to: I mm@freedomescrow.com
For Inspection call (Name): N/A 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'ssignature to authorize inspection: Date:
OR
Owner/Agent's signature to decline inspection: / �7 Date:
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORTBEACH ,
Builaing—Divisi.n\Forms\HBP 7-30-20 I°