HomeMy WebLinkAboutR2022-0032 - Permit ApplicationPrint Form City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
TUnq,0On2, 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
RBR# `� '7 www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
Application Fee: -$198.00 Notice:
(For AIIResidential Buildings) Applications with insufficient fee payment
Reinspection Fee $131.00 or incomplete will be returned
Please type or print and complete all information
It of Units: I ` ; Address: aaa �n ,r A. e J� City: Newport Beach', State: CA Zip q UYIQ
PropertyOwner: Zip Code:
Owner Address: nnnn City:
State:CA .. I� Zip Code: Home Phone:
Owner's Authorized Agent:
Agent Address:
City:
State: Zip Code: Agent Email Address:
Escrow Company: I --e—e-666 - 1;�,cr-oW
Escrow Address: I �W�rcc�q
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State: I l.F.i Zip Code: A(o(1
J Email Report to: i2C)C) t e u—k_CGr\-ter_CD,. U-1&0 (3e,�,cx,
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For Inspection call (Name):
Work Phone:
Escrow #: 105 S t31—� uj
City: I )je-w For* - -_
Escrow Phone: C/c/�_ (otft/_3938
Cpr 9aoro2 �
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 responsible to correct said violations.
Owner/Agent's signature to authorize inspection:
Owner/Agent's signature to decline inspection:
Building Division\Forms\RBR 7-1-21
Date:
Date: 1 -1�'2 _--
Account It 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH