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HomeMy WebLinkAboutR2020-0905 - Permit ApplicationqqW City of Newport Beach rlvE" -OMNJIUNITY COMMUNITY DEVELOPMENT DEPARTMENT F)EVEl-OPPAEN, BUILDING DIVISION 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA926E(✓8999T,5© 2020 RBR# KIM - O90 S www.newportbeachca.gov 1 (949) 644-3200 CITE/ OF Application for Report of Residential Building Records RAN I Application Fee: - $194.00 Notice: '` W,oQRT:. (For AIIResidential BuOdings) Applications with insufficient fee payment Reinspection Fee $129.00 ' or incomplete will be returned Please type or print and complete all information #of Units:Q Address: alq u,1 kxyttJ�, City: Newport Beach State CA IZip: _ . ------ aba- PropertyOwner: 6P 11 qb%4 A`. hctl itR,Y 1 Zip Code: �y6dY 1,! Owner Address: .a)O(_OpcJ kjon g, City: 01201-vaB� -- --- ---- State: CA„ Zip Code C -:46y 'l,. Home Phone: Owner's Authorized Agent: Work Phone: �— Agent Address: City: State: Zip Code Agent Email Address: Escrow Company: ,Iek(,dye. Escydw Escrow#:l Or 1—jll 3 :... Escrow Address:(,.yw �p�,o�,s-4 ��„r�� ()�• 1&Q City: Q�,.,.� tLX p State: CF Zip Code: �hbb'Y ( _...-._ N crow Phone: 9-y 1 6-� l� • �j 3_- \ Email Report to: -y" Q, COM L..... For Inspection call (Name) Direct Phone: CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW) - 1 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: Dater O Owner/Agent'ssignature to decline inspection: Date: I)I7d ar);; Account # 01050504-521040 ..................Make checks payable to: CITY OFNEWPORT BEACH Building Division\Farms\RBR I-30-20