HomeMy WebLinkAboutR2021-0409 - Permit ApplicationV
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Pnnt F6 City City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
RBR# �4/-o�°' E 100 Civic Center Drive I P.O. Box 1768 1 I Newport Beach, CA92658-8915
www.newportbeachca.gov ov 949 644-3200
Application for Report of Residential Building Records
Application Fee: - $194.00 Notice::
-:(For AIIResidential 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 DL' �` • i,�._ J! City: Newport Beach I State: ��Zip:En�,",j
Property Owner: -WA C))X\c,1 >\ ���-VIOU�+.l t.Jk. .toll Zip Code:
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Owner Address:5Lt,'i-�,(jg'r'r�� V<t.� City:
State: CA Zip Code: '"; '""ate" Home Phone:
Owner's Authorized Agent ( V\-,, \ Work Phone:
Agent Address: iJ�-4�J9.1J��)t1V, �..y v ,fir >� f City:.,kT�'} /'�..i�..-__...
State: FTT77 Zip Code Ft -2,0I 01 Agent Email Address:
Escrow Company: /, �/ 7y�;'`�y�\I\1'Escrow #`
Escrow Address: �. C7 ub V�-4 �-i��l`;`� L.. JUS i..-s.JVr cJIY City ---- �t l�l �'4JlSV. "`..y .; ' G�•-1-/a�-._..-.___.._J
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State: !iSK Zip Code �'��"`��t,(„Q. Escrow Phone:
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Email Report to:
,C -UN -v\ c�
(0 1
For Inspection call (Name): Direct Phone:
CONSENT TO INSPECT (FORM MUST BE. SIGNED & DATED BELOW)
I authorize inspections and re -inspections ofthl
violations are discovered l will be responsible to
Owner/Agents signatureto authorize inspection:
Owner/Agent's signatureto decline inspection:
Account # 01050504-521040 .......
Building Division\Forms\RBP ]dOQO
property listed above. I understand that if Building orZoning
correct said violations.
Date:
'L✓ / Date:
to: CITY OF NEWPORT BEACH