HomeMy WebLinkAboutR2020-0830 - Permit ApplicationrCCEIV81)
COMMUNI'i Yy
Print Form City of Newport Beach DEVELOPMEW)
COMMUNITY DEVELOPMENT DEPARTMENT SEP 2 5 2020
BUILDING DIVISION
hh pq 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
RBR# R1��'' 9 J� www.newportbeachca.gov 1 (949) 644-3200 CiTyor
SIX
Application for Report of Residential Building Re8('9 Vv -
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
# of Units:FnAddress: 110 Via Lorca City: Newport Beach State: CA Zip: 92663
PropertyOwner:soh r) U�o n I S Zip Code: Z,4%3
Owner Address: 1110 V((4 I � rc �A City: ,��%pay-f
State: CA Zip Code: W�1 l- Vi Home Phone:
Owner's Authorized Agent: �' I I Y r �.� Work Phone(:-
Agent Address: '1� I S' Wes �COL-t 6 V City: VC + (A V l Ila , —
State:�— Zip Code: -I �� I Agent Email Address: �Y-1gbn f, -(g mc, I I -�:I,''yn/�.
Escrow Company: RidgeGate Escrow, Inc. Escrow #: 500 -104025 -MT
Escrow Address: 9151 Reseda Blvd. City: FINorthridge
State: CA Zip Code: 91324 Escrow Phone: 818-993-4707
Email Report to:
For Inspection call (Name): LST cbr i 76Y—F? S U Direct Phone: I b l(S (-Q-362-r1--5
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 Iwill beresponsible tocorrect said �I do ,
Owner/Agent's signature to authorize inspection: Date:
O
Owner/Agent's signature to decline inspection:
Building Division\Forms\RBfl 7-30-20
Date:
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORTBEACH