HomeMy WebLinkAboutR2024-0011 - Permit ApplicationCity of Newport Beach
RECEIVED By
COMMUNITY DEVELOPMENT DEPARTMENT COMMUNITY
BUILDING DIVISION DEVELOPMENT
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92651-Ml#2 N24
RBR# 1ti�A2`1' bDi� www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Buildine Record&,:CRY, of
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Application Fee: - $208.00 Notice:
(For AIIResidential Buildings) Applications with insufficient fee payment
Reinspection Fee $138.00 or incomplete will be returned
Please type or print and complete all information
# of Units: F7( Address: l(05- N� �rTl"��y �8,��- City: Newport Beach State: CA ❑
Zip:
PropertyOwner: L-0-wr,eKC'eS-g-oy\(Zip Code: Fwil
Owner Address: l(oT No, -°fit F—V-0 � City: P,PW 04 'gC4C�
State: F771 Zip Code: ''56 Z Home Phone: `ads 86(--(021
Owner's Authorized Agent
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Agent Address:
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Zip Code: Oj'a tOiO Agent Email Address:
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Escrow Company: T'rCYAoY
Escrow#: (j y(pco-i
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Escrow Address: 1200
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Escrow Phone:
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Email Report to:
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For Inspection call (Name): �/ I Direct Phone: L N
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: Date:
OR
Owner/Agent's signature to decline L-V �,y.��yW\,��—,,,,_,,,,yDate:
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Account iF UlUSUSU4-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
Building_ Division\Ponds\RBR 5-15 ZZ