HomeMy WebLinkAboutR2021-0493 - Permit Application�' UGf=.tVFO
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E WWII < City of Newport Beach COMMUNITY
COMMUNITY DEVELOPMENT DEPARTMENT 0EVELOPm ENi
BUILDING DIVISION
`(J�{1•(�1I IL}f,110 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915 JUL O 8 21727
RBR# www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records i;ITY OF
Application Fee: - $198.00:. . Notice: . "*PORT Fop,
.(ForAll Residential Buildings).. , Applications with insufficient fee payment
Reinspection Fee $131.00 or incomplete will be returned..
Please type or print and complete all information
#of Units: I r Address: 201 61f �M ilpyy-� City: Newport Beach _ State cA ;Zip: 92163
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PropertyOwner: /" icha e.1 47 416'-brk HouX � Zip Code.
Owner Address: (0001 P&, aynericaw ��5 >` FN t+� City:
State f*D, Zip Code: 5'%t09 _...: Home Phone: -5,D
Owner's Authorized Agent: Z6.o- ,t1� Work Phone: �f'Y�.��'�i 02C- _.
J �a u v _ ...._ _. 7y ---
Agent Address: /7,90__. i'O,Cti *(Of _.. _.. _...� city ux•i/ra Lp rl. USA
State IZip : I /
hr,� Codeas irZ -yr Agent Agent Email Address: �CO'/,CyCAI'ktpBECC &9CTo k°S••Paei
Escrow Company: ����r���/_�-�.S,C von✓_. _._ Escrow#: -75'22
Escrow Address: y00 et me -I City:
State:I Zip Code: Escrow Phone: 7/y
Email Report to: lj Co / C A M�B�GLR�r�-G TO✓:S• coAoq
For Inspection call (Name): N { Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
I authorize inspections and re -inspections of the property Iistedabove. I understand that if Building -orZoning
violations are discovered I will be responsible to correct said violations.
Owner/Agent's signature to authorize Inspection; Date:
Owner/Agent's signature to declineinspection: bate:
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Account # 01050504-521040 .................Make checks navohle tar &TY OF NEWPORT REArN
Building DNislon\M,m5kRBR 7-1-21