HomeMy WebLinkAboutR2021-0670 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
V14110100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
RBR#
www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
'. Application Fee: - $198.00 Notice:
(For AIIResidential 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: Address: 93Gl 8CLA/ A-Ve City: NewportBeach i State: CA Zip: g2 6(o'
Property Owner. I . F1ainc, -,kr)s(3fl
Zip Code: F925tp
Owner Address: 14311 go M to h>I or,' -Kr) 4k 280 3 city: 12 rri e C1,j CL.
State: CA ,. Zip Code: -I2 -59,A ._. Home Phone: 95.1- 522.- Q5I 8
Owner's Authorized Agent: 1. 6-ar GTrP er
Agent Address: 133GOG \jinn VV
Work Phone: 951__-
City: l2Gt_i,LGL J
State: �a,� Zip Code: q,2, 9 i
_ ___ Agent Email Address: +e_Q m 4 9 re6 _ q MCLL1 C0 _)
Escrow Company: Escrow #: �— v
Escrow Address: City:
State: Zip Code: I Escrow Phone:
Email Report to: am -o reec q rno� _l . con-)-,. .
cJ 1
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 l will be responsible to correct said violations
Owner/Agent's signature to authorize inspection: Date:
OR
Owner/Agent's signature to decline inspection: C7 Date:
Account # 01050504-521040 .................Make checks oavable tn: CITY OF NEWPORT RFACH
Building_Division\vort s\RBR_7-1-31