HomeMy WebLinkAboutR2020-0928 - Permit ApplicationDo(c�u'S'.ign Envelope ID: 913B8B4B-7AC5-49D1-A811-940EBA241555
I ;,'�ni,t o,ip City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
G 100 Civic Center Drive I:P.O. Box 1768 'Newport Beach, CA
RBR#2o%v ° 092-9 www.newportbeachca.gov ( (949) 644-3200
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Application for Report of Residential Building Recor
ee: -:$194.00 Notice:
ential Buildings) ` Applications with insuffW
Fee $129.00 or incomplete will blWeti
Please type or print and complete all information
# of Units:
Address: h
cit New ort Beach State: CA !Zi
Property Owner:
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Zip Code: 0
:Owner Address:s.'ro, '"'S�.'•5^�.a_R:4 ...._._...._._ City: (�.i...!.........L.`C"s+.�..- ---.._''
State: CR. _ - Zip: Code: Fk�c!� Nome Phone:
Owner's Authorized Agent:{•� ,��,,") Work Phone: „__...
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Agent Address: '��-\.vt��aa'''s'ti�'d` ,.,t City: -._.
State: 1 rg Zip Coder try Agent Email Address:
Escrow Company:'Escrow# Yi j �✓
Escrow Address: City: i �--
State Zip Code:; Escrow Phone: �'1 �j_ l ®�i(� 11
Email Report to: I C-7> k:5 L_ ca
ism
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.
Owner/Agent's signature to authorize inspection: Date:
OR
Account # 01050504-521040 ................Make checkspayable to: CITY OF NEWPORT BEACH
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