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HomeMy WebLinkAboutR2022-0306 - PermitsCity of Newport Beach COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION Z 03& 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915 RBR# www.newportbeachca.gov1(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: L J Address: 305 La©(�� Ot- - City: Newport Beach State: [CA]Zip: Property owner: �;lvc vA�vti� -{Le Kl_ uL c- zipCode:� Owner Address: Pm P (-e. I d2v�- C - J City:yL� ✓ Gl Q- w� J 7 city: State: CA J Zip Code: w 26�i�j Home Phone: (c(�-tGl� c{ 13 h �ij Owner's Authorized Agent: eta (1,w-(� Work Phone: C�LIGi Gt (3 5�� ------------------------- Agent Address: (c( C4, City: State: C C.v __ _ — Zip Code: - �_ 4C A ( Agent Email Address: 1 Vc� r V-40L4L -4 g GI�y.S'tI, w Escrow Company: y ,:,"-mow 0 �; o r� 6 rv�. Escrow #: - I L Escrow Address-. lr�-1 �rj) �rv� C:,r2� fir✓-�- City: Tr�b� ---------------' _- ------ ----- - -- State:.- ('(^ Zip Code: Escrow Phone. CCQ4) C(o 160 Email Report to: Cti�^'� C o e-Q to v/ e For Inspection call (Name): e, ����, �'� I Direct Phone G(✓(zj� g �(� CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW) I authorize inspections and re -inspections of the property listed violations are discovered I will be responsible to correct said viol Owner/Agent's signatureto authorize inspection: OR Owner/Agent's signature to decline inspection: nd that if Building or Zoning Date: 1 6 12;7- (;3 . Date: Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH 8UIIEIne_BWISIon\Forms\RBR_7-1-21