HomeMy WebLinkAboutR2021-0162 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
n/) n� , O � Z 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
RBRtt Y U/U www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
Application Feer- $194.00 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
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Property
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Zip Code:
Agent Email Address:
Escrow Company:_...9'-I t_._ W 7, t o W
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State: F-7— Zip Code: l Xj-7 /;
Email Report to:
For Inspection ca
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:
B01dm,DwW.n\Forms\RBR 7-30-20
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Date:
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Account # 01050504-521040 .................Make checks payable to: CITY OFNEWPORTBEACH