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HomeMy WebLinkAboutR2020-0929 - Permit ApplicationRECEIVED 4y- Print Form City of Newport Beach COM" INiTy COMMUNITY DEVELOPMENT DEPARTMENT OCT BUILDING DIVISION Y I�FC'D 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915 RBR# Q www.newportbeachca.gov 1 (949) 644-3200 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: Address: �'�- �c �/ ���� _ City: [Newport Beach State: CA ,;Zip: q &,y7 - Owner Address: State: CA Coos �j UCb' 7y�.�✓^9 � Zip Code. 57i _... __ n Zip Code: _ City: )U" pnk-(. \_ 0-140-j Home Phone: FTC—(, , (, t O - 2o4(7 Owner's Authorized Agent: Agent Address: Work Phone: 244 4 l( (021-o City: fi�11VnIV6.l �'>�/../: State: I �, Zip Code: o Agent Email Address: Escrow Company: VU��I^^;;,. i"�'fb jN,/� Wl.'1`-.;V V//�"..... Escrow #:/I�(.. (yrt�,��, � 1."'-1112 C-7 ' Escrow Address: ... V 7 X41 A " J 7/0... City: .. N- U _e.M✓I 1... State: I OF Zip Code: Escrow Phone: l - 7.7 -�q Email Report to:I._...�i.�l'i.TrUc�IA.!L©Vv.�....l...i1J._. 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's signature to authorize inspection: Date: I� Owner/Agent's signature to decline inspection: �l��f--�_ Date: tD 'Z(� zz) Account # 01050504-521040 .................Make checks payable to: CITYOF NEWPORT BEACH B.[1ft,0wi,mn\F.,.:\ABR 7a0-20