HomeMy WebLinkAboutR2020-0912 - Permit ApplicationPrint Form
City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
QQ 100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA 92658-8915
RBR# FU 10 - Og i1- www.newportbeachca.gov (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
9 o Units: F Address: I t 1 6olie rC) 1,f City: Newport Beach State: Zip: Flibo3
PropertyOwner:l Wd 'E- sn,66
Owner Address: I g1b_1 gClQfo
State: CA Zip Code: qr 2�U 0
(�q Zip Code: cf
City: N�dJ�1T(� GJL a
Home Phone:
N—
Owner's Authorized Agent: OvJOO, Work Phone: mfE9H°
Agent Address:
City: I U1 21 EJ
State: F Zip Code: F Agent Email Address: ^ Dc-VELOPMENT rvT
Escrow Company: -Ft S l- a /my e rl c a o Escrow #: 11 32�j l7
Escrow Address: -�(5+ off)-P(tCA(i WA1 city:Sun-A o(W
State:/\F Zip Code:�'5.1n, Escrow Phone: 1-114-75D- qoOq
Email Report to: Vt l4� )'`Z, (� � S-�' �m . WAn
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:
Owner/Agent's signature to decline inspection:
Building 0JW,i.n\Forms\90R 3d0-20
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Date:
Date:
Account 9 01050504-521040 .................Make checks payable to: CITY OF NEWPORT REACH