HomeMy WebLinkAboutR2023-0527 - Permit ApplicationRECEIVED BY
COMMUNITY
DEVELOPMENT
Print Form City of Newport Beach JUN 09 2023
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION CITY OF
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-891 5NEWPORT BEACH
*m fR2oZ 3 - 0 5 2"1 www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
Application Fee: - $202.00 Notice:
(For AIIResidential 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:FF Address: t739/f-gyytay pVtve Crty:NewportBeach State: CA Zip:
9Z4Qto/
Property Owner: `jam n-r� �1aY,y-r ��•Sr l'�C74 RSV+•, ?Y', Zip Code: F—
Owner Address: 4,2- z N I�Q3DYJaQr J/l� City: >�10Y-EAceG
State: Z Zip Code: RV 5i 32, Home Phone: q5- 23 (Q
Owner's Authorized Agent.: ✓a U'') d j, r V4 Work Phone: -7 27 . 3 $ a2
Agent Address: 2-I SO ® YDY6LA- LA i1(J A 63 V c.� city: �/Or._66. V r1C[A_
State: CA Zip Code: ag$� Agent Email Address: davi Q pL. /y i Ve meCt- V-I f\q . CO m
Escrow Company: - -(�nSJ C,5A CV'0 Li Escrow #: t 15307 n 4 -- 531.5)
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Escrow Address: 2l5$0- 6 \/orba U od a- B vA city: N W Q Rd oc
State: k Zip Code: R r) Escrow Phone: Y7l 4 ry r-1- 41,00
Email Report to: IPa W49,tVI•hneIgC_ Q tilesfcocas4EscraCA) F Co NN rr1
For Inspection call (Name): .�av 14 S I I v Ck Direct Phone: rt 4 r 721-- 3a y.�
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's signature to authorize inspection:
OR
Owner/Agent's signature to decline
Date:
Date:
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
Bui1din,0.d.n\Forms\RBR_61522