HomeMy WebLinkAboutR2020-0350 - Permit ApplicationPint Form City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
^ 100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA92658-8915
RBR# C/� lz www.newportbeachca.gov (949) 644-3200
Application for Report of Residential Building Records
Application Fee: - $191.00 Notice:
(For All Residential Buildings) Applications with insufficient fee payment
Reinspection Fee $129.00 or incomplete will be returned
Please type or print and complete all information
#of Units: IAddress: .0 (Lll�N �e. '.... City: Newport Beach State: CA IZip: (,jzZL
PropertyOwner: 1aLd C:SnQvd 1.1.tJ.
Owner Address: I City:
State: CA Zip Code: I Home Phone:
Owner's Authorized Agent: Wald i bycims Work Phone
Agent Address: F City:
State: ��. Zip Code: F Agent Email Address:
Zip Code: j!
Escrow Company _ I, n �/f U _._ �.'/�,.. _ Escrow #:I C)SA—7(o/�
Escrow Address: _ W?Nt..� N. _-*gNity... fi�iil'c G.Ch
State F— Zip Code: v! Escrow -'Phone:
n I
I
Email Report to:
For Inspection call (Name): Direct Phone:
I V
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
At." \.J LV r
N�4
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:
R
Owner/Agent's signature to decline inspection: Date:
V IV
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
Building Division\forms\RBR 9-18-18