HomeMy WebLinkAboutR2020-0934 - Permit ApplicationPrint Form City of Newport Beach CeIVED a
COMMUNITY DEVELOPMENT DEPARTMENT COMMUNITY
BUILDING DIVISION DEVELOPMENT
v'yyl�'100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA9265 $9�1
RBR�99V W 6 `' , www.newportbeachca.gov (949) 644-3200 o I J V 2020
Application for Report of Residential Building Records;ITYOF
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Application Fee: - $194.00 Notice: N�WORT DEP
(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: I ` Address: 2 (01 DE5CArJS0 City; NewportBeach State: CA Zipffz( 60
Property Owner:
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Zip Code:
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Owner Address:
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City:
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State: CA
Zip Code:
Home Phone:
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Owner's
Owner's Authorized Agent: I.L<41-AN/ A"Of-j Work Phone: 194q
Agent Address: I lg00 NEOUPOA-r C-rO-- -3�-' )OU City: N g
State: G'. �Zip Code: 92(,v6,a Agent Email Address:
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Escrow Company: I l^rvT(Sr- (3LA 5Er—L`AC1;5. Escrow #: I3j9a 73. 02.0
Escrow Address: q"010 MIILU-(.ICF/`J AVr. City: (.1�}NG�-o C-S.AMOrJ(.A,
State: EA- Zip Code: �' n 3 Escrow Phone:. �'. q I _ %4 Q ( f
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Email Report to: I of;ZQu�L G46E4 \AAt\.l n ,PQ F'.CAIM
For Inspection call (Name): i Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
I authorize inspections and re -inspections ofthe 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:
Owner/Agent's signature to decline inspection:
Bulldin8_DIW.s \Forms\R8R 730-20
Date:
Date: I 10,56
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Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH