HomeMy WebLinkAboutR2020-0820 - Permit ApplicationPrint Form City of Newport Beach Rec
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION co�M� mr
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA9264&& 5
RBR# X201.4 - 0120 www.newportbeachca.gov 1 (949) 644-3200 p
9FCa
Application for Report of Residential Building R&orc i,%,,,
Application Fee: - $194.00 Notice: 'ORT BEPO"
(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: 3 Sabastian City: Newport State: CA Zip: 92660
PropertyOwner. i. Zip Code: -
Fred Eward Nowrooz_ &S3dA__M. Nowroozii 92660
Owner Address: City:
.3 Sabas.tian__.__ _ Newport Beach.
�i
State: CA. _. Zip Code: 9� 266p Home Phone:
Owner's Authorized Agent: Shala Nowroozi work Phone:
Agent Address: 1-4 Dauphin City: [Dana Point_ -
State:' Zip Code: ��2t 629 Agent Email Address:
Ca, Shalanowroozire@gmail.com
Escrow Company: Escrow#: N2f1--0.0236-TE .
Escrow -Technologies ---
Escrow Address: City:
5000 -Bir -ch Str-eet -Suite---30-00-352 Newport Beach
State: Ca Zip Code: 921 660 Escrow Phone: 949 945.2914 _.
Email Report to:
..__Terri@escrow-tech_n-et-
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 orZoning
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:
Account # 01050504-521040
Building_Olvision\Forms\RBR 7-30-20
Date: l _ _.......
OR '111712 0
120
Date:
Make checks oavable to- trTY OF NEWPORT BFA[H