HomeMy WebLinkAboutR2023-0638 - Permit Application►Z 2023- o(-38
W? Om- E RECEIVED BY
r City of Newport Beach DEVELOPMEEN
°.1"t r'' to NOW f �'r�" COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION JUL 18 2023
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-891�ITMOF
RBR# R-ZD23 - O(o 3% www.newportbeachca.gov 1 (949) 644-3200 NEWPORT BEACH
Application for Report of Residential Building Records
APPlication Fee: $202 00a { Notice:
(For AIIResidential Buildings) .'._� n f� Applications with insufficient fee payment
Reinspection Fee $134.00nk` ,�.:� - or incomplete will be returned
Please type or print and complete all information
#ofUnits: Address: la D City: Newport Beach State: FZiP:�
Property Owner: A 15�(,(y SCLr-, ,,-0iY;{✓ Zip Code: C(t3
Owner Address: Qgs- StinOGtNI�Q�rp� W N- 6� City: 5C44 IGV-jA
State: L J Zip Code: -1 (30 � Home Phone:
Owner's Authorized Agent: Mqr i IGK 0,k of Work Phone: (`} (4)
Agent Address: NCvv oar Ci Krems Dr, I1-TU3 City: {W(16r- Tr4C�
State: Zip Code: Agent Email Address: KAarrOlN"I4ghiKP0L^06•(60�
Escrow Company: P-rY Oi scro Wff I Escrow #: Dg2S,��i6Cl ^ L�
Escrow Address: P-00 PTfw,f6^F 6xaH^ �r�� �80 City' ke o I�raC�
State:
Zip Code: Escrow Phone: la yOt 6 3 3q
® �I 0 i -Z
Email Report to: I ,-efdoo,PSC-OWh ICo� f0 cU iirorowle5C1-oW � c o" '
For Inspectioncall(Name): MAr;r>,h Direct Phone: 1�-(e.�)26cp �S�
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 or Zoning
violations are discovered l will be responsible to correct said violations.
Owner/Agent'ssignature to authorize inspection:
Owner/Agent'ssignatureto decline
Date:
OR
Date:
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
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