HomeMy WebLinkAboutR2021-0252 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
p q+ , �� �,s100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
111131144111131144www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
Application Fee: - $194.00 Notice:
(For All Residential Buildings)Applications with insufficient fee payment
Reinspection Fee $124.00 or incomplete will be returned
Please type or print and complete all information
It of Units: Address: yl City: Newport Beach State: CA !Zip: (j
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Owner's Authorized Agent: "T
Agent Address: /3s I / 47 xlv ll� �
Work Phone:
City:
State: C Zip Code:�?B 0 A ent Email Address:
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Email Report to
For Inspection call (Name): Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
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