HomeMy WebLinkAboutR2023-0589 - Permit ApplicationP�202.3 - 0 .� -1
Print Form City of Newport Beach RECEIVED BCOMMUNITy
COMMUNITY DEVELOPMENT DEPARTMENT DEVELOPMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA92658-89 M 2 92023
RBR# KZ oZ 3 - p5$ q www.newportbeachca.gov (949) 644-3200
CITY OF
Application for Report of Residential Building Records NEWPORTBEACH
Application Fee: - $202.00 Notice:
(For AN Residential Buildings) Applications with insufficient fee payment
Reinspection Fee $134.00 or incomplete will be returned
Please type or print and complete all information
# of Units: Address: 103 (f 1k 1-t 1-;Jo 5ooJ City: Newport Beach State: CA Zip: /ZO 63
Property Owner: 6cmi,J ifribal Zip Code: `ll34-7
Owner Address: 7Ap0 OxAard 54. "Its0p City: F 4100d1(wvr6l E/7 f1$1 CA
State: CA Zip Code: F11317 Home Phone:
Owner's Authorized Agent: /Zrgy T re- Work Phone: 71 y- 6 /Z- 13g6
Agent Address: 300 E' P",-t 6 C.. v. 14141, City: n,4 NV, j3,C�.CiLi
State: (�H' Zip Code: 9-& y g Agent Email Address: K�r4N Pi Dv-c+v+�i) �f ernl GS }q,}z lapty�
Escrow Company: Gx;r cw O -r t) IG Escrow #: 13Z3 500-15
Escrow Address: 'Z y y 5 7-o wh 5 atc ILL Sv tZ City: V;
�LOO
State: zip code: dlJ36 J Escrow Phone: Z-f6 4xZ$
Email Report to: L+4-, C4--1 (}' /Z jr.v Q 5+4-4i I- Cti.�'`bS+h�G, (own
For Inspection call (Name): 97e, %rl Direct Phone: I 7(Li-6/Z-13$�
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 I will be responsible to correct said violations.
Owner/Agent'ssignature toautlprizeinspection: �:��y4z c�N Date: 6 Z5-Z-3 _
\� OR
Owner/Agent's signature decline Date:
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
BAdm,0.WW.n\Forms\RBR 6-1Bd2