HomeMy WebLinkAboutR2021-0346 - Permit ApplicationPrint Form
City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
t�/JD ry I �Q �I r 100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA92658-8915
RBR# I� CC L j'"rU! www.newportbeachca.gov 1 (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
# of Units: I / Address: L1C� Oq /� �� 10 5 ,Cit : Beach State: CA i,, Zip: 2(P6
Y[Newport
Property Owner. Oh l7leo._ s, -/. 7W r:i ort_.. Zip Code:—Z4�
Owner Address: 116City: /
c 4 Ve S /YC�Wor� _.f✓�e�eC'7 _.._ ----
State: CA_. _.... Zip Code: FZ(3 Home Phone: qj lq $�y.� ole -S-1
Owner's Authorized Agent: 111111- f-4 j j'All< Work Phone: I G1L1 q - 3,72- 37_ a
Agent Address: 40.44O Oar -RNC,— %iC 4J - `1 G a City: -rr Y),7 t f
State: Zip Code: % Z 6 O Agent Email Address: - _..
19 �l9tfrl-�r���jarre5(e t?n)e. /1Gt- J
Escrow Company: �ry��� elz41PS J�6dr-rLy ':, Escrow #: 7 -726
Escrow Address: ZoydZ 91-2;1-54-4 U r -5t 4 -;t/v/ City: fy,n.�Gy71-6/7 804ad7
State: Zip Code: F19Z(L�/�j! Escrow Phone: '714 - .3 %�
Email Report to: j --/^)`/het �C.v jt-er/1e5..25e-l-o4." 0,0 v7?._
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 Division\Forms\RBR 7-30.10
Date:
OR
�-, Date:
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH