HomeMy WebLinkAboutR2022-0022 - Permit ApplicationP[Int Forma =" City of Newport Beach *CFIVED ey
COMMUNITY
COMMUNITY DEVELOPMENT DEPARTMENT DEVELOPMEN)'
BUILDING DIVISION trill
U 1/) 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-89'15 I $ 2022
RBR# TUU GG I/U PI/ www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building RecorCITY OF
ds
0.
Application Fee: - $19B.o0
(For All Residential Buildings)
Notice:
Reinspection Fee $131.00
Applications with insufficient fee payment
or incomplete will be returned
Please type or
print and complete all information
#of Units: Address: 608 1/2 Orchid
City: Newport Beach', State: CA ;Zip: 92625
Property Owner: Orchid Pacific Limited Partnership Zip Code:-
Owner Address:
6o8 I
lL OrcVtio(
Cit
y` NewrA
State: CA Zip Code: l�� 2.5
- —
Home Phone:
31 o_-ZR4213y -
Owner's Authorized Agent:
Raymond Lau
Work Phone: —
310-294-2134 --
Agent Address: L1z/F 0 .GO Coe �
L4ULF x
City:
Hermilso,
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State: CA Zip Code:F0Z z{z{
5
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Agent Email Address: raylauexp@gmail.com
Escrow Company: Tri City Escrows, Inc.
Escrow #:
Escrow Address: F23440 Hawthorne Blvd., 11100
City: Torrance, CL
State: CA Zip Code: 90505 __.
Escrow Phone: 310-326-7601
Email Report to: 10ri0.tricityescrows.com
For Inspection call (Name): Raymond Lau
Direct Phone: 310-294-2134
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 I will be responsible to correct said violations.
Owner/Agent's signature to authorize inspection:
Date: ial, iit4 2022
OR
Owner/Agent's signature to decline inspection:
Date: :
Account It 0105OSO4-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
.iltling_Divislon\Forms\RBR 7.1-21