HomeMy WebLinkAboutR2020-0914 - Permit ApplicationpnntForrrf City of Newport Beach
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COMMUNITY DEVELOPMENT DEPARTMENT 40 OpMEN1
BUILDING DIVISION oCT 2 2 Z0Zq
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
RBR# www.newportbeachca.gov 1 (949) 644-3200 1 ot FV OF
Application for Report of Residential Building Record, ... op
Application Fee: - $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
# of Units: Address: I � � C) ` I
City: New State: Zip:
Owner's Authorized Agent: Work Phone: 'Lcl)- Lc�s —
Agent Address: f\ -D— NO g— City:
State: Zip Code: F—a.V-P- Agent Email Address: Id> C', 0::) 0-b
Escrow Company: i
I f Escrow #: �'4( k 3 J Ci)
Escrow Address: city:
State:Zip Code: Escrow Phone:
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Email Report to: I b cc> C -D Tr)
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 responsibleto correct said violations.
Owner/Agent's signature to authorize inspection: Date:
OR
Owner/Agent's signature to decline inspection
Date:
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
BW[dm,DM,i.n\F.,.s\RBR 7-30-20