HomeMy WebLinkAboutR2023-0396 - Permit ApplicationCity of Newport Beach COMMUNE
COMMUNITY DEVELOPMENT DEPARTMENT DEVELOPMENT
BUILDING DIVISION MAY 0 9 2023
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
Raw# fL 2p7-3 — 101,cit 0 www.newportbeachca.gov 1 (949) 644-3200 CITY OF
NEWPORT BEACH
Application for Report of Residential Building Records
Application Fee: - $202.00 Notice:
(For All 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: City: Newport Beach
State: CA Zip:
Zl 7
Property
Owner Address:
State: CA Zip Code:
Home Phone:
Owner's Authorized Agent: F Work Phone:
Agent Address: City:
State: Zip Code: Agent Email Address:
Zip Code:
Escrow Company: 7 c, Escrow #: I✓ �'�
Escrow Address: V�l%� � -- � City: I Ajafo
State: I C t Zip Code: MiiP Escrow Phone: gTq,— N "3
Email Reportto: I �y t gTu ffoyN'LC Sc-12l. CR) -CL M �'��I.QuI iom
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 wi H be responsible to correct said violations.
Owner/Agent's signature to authorize inspection:
Owner/Agent's
Date:
Building Division\Forms%RBR_6-15-22
Account # 010SCSO4-521040 .................Make checks payable to: CITY OFNEWPORT BEACH