HomeMy WebLinkAboutR2021-0816 - Permit ApplicationRBR#
City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach,
3
1
CA 92658-8915
www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Buildine Records»,,
M�
Application Fee: - $198.00 Notice:
(For All 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: Address: l ���I ' tQMtEf� y: Newport Beach State: CA Zip:
Property
Zip Code:
n n
Owner Address: 11'335
State: CA Zil
Owners Authorized Agent (j j_ Work Phone: D -D
AgenL Address: I3 3 '"� \:fv� `1d� City:
1i R 1 f 1 Y I Vi s
State: F C ,(ate Zip Code: Agent Email Address: 6L Lo
Escrow Company: n ' Ar,.c �'1 A ", Escrow tO vt.?J�0 61i�/�
Escrow Address: W 117' ��(r O2x 6 City:nl
State Zip Code: I Esi:row,Ph ne: CILIA
l�r 1 v )ur1
111,1 IAF" ! � � 4
r S 1!4nllca (Name):I
I.CONSENT 'TOINSP
r
el IIJ i.�l�lil � s
Direct Phone:
'ED BELOW) SII
la hl
violE�ti,
'll li�l'
IOwni
ars
lI'
y
�spectionsandre�insp,ecti_onsoftheprppertyliste2i�
°re discgveredlwillllber
I�lllIIII
Itis Sig natuletoauthoriz�linspection:
i
sponsibletoIcorlrectsaldvi�la
I'
�
bove.lun
ions.
S I
I
ersiandthatifBujld�ing
i
Date:
I
rZdni
g.,
li.
I
O`•^,'r1
i PIr
�l1AI1'}fI'ICjn(I'tsslgnaturj
I
I
�
odeclinel
I I
pection:
I I
Date:
I
ssj� : IFIs AcIcaynt # 0 10 5 0 5 04-52 1 040 .....E .. {....Mak c cks payable to: CITY BEACH
Ift OFNEWPORT
Build g o otl Yorms\ 811 7-1-21