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HomeMy WebLinkAboutR2022-0003 - Permit ApplicationPrint Form City of Newport Beach COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION tnn Wll,M 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915 RBR# www.newportbeachca.gov 1 (949) 644-3200 Application for Report of Residential Building Records Application Fee: - $198.00 Notice- (For All Residential 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: RD Address: 0011 I� S \ S ` City: Newport Beach State: CA ',. Zip: F1aWS PropertyOwnera \--�JIA) �. �.. `F'�'� �� Zip Code: Owner Address: _ `1 l 0�. (� City: State: CA Zip Code: r Home Phone: Owner's Authorized Agent: Work Phone: �— Agent Address: City: State:— Zip Code: F Agent Email Address: Escrow Company: \ Escrow #: O Escrow Address:City : I'La U N ey��. r a— ('YtiL-•- ��'• State: Code. Z'/2(�(,� ',. Escrow Phone: Email Report to:f� J �-rir.C�L1,nn.2SCrYl�.l. ' LOf',1. _. .. For Inspection call (Name): Direct Phone: �— 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: Owner/Agent's signature to decline inspection: Building Division\Forms\RBR 7-1-21 OR Date: Date: 12 Account # 01050504-521040 .................Make checks novable to- CITY OF NEWPORT RFACH