HomeMy WebLinkAboutR2023-0442 - Permit ApplicationPrint Form City of Newport Beach co EDBBy
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UNITY
COMMUNITY DEVELOPMENT DEPARTMENT DEVELOPMENT
BUILDING DIVISION �,y
100 Civic Center Drive I P.O. Box 1768 Newport Beach, CAKAq58-40023
I'MR4 (LZo23 — 01+47— www.newportbeachca.gov (949)644-3200
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Application for Report of Residential Building Record RTBEacH
Application Fee: - $202.00 Notice:
(For AIIResidential Buildings) Applications with insufficient fee payment
Reinspection Fee $134.00 or incomplete will be returned
Please type or print and complete all information
# of Units: T Address: ,7! IZ L i1 A City: Newport Beach State: CA Zip:
Owner Address: V0/4;1 `�rffG _G�U1
State: P Zip Code:
Zip Code:
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Ive Home Phone:
Owner's Authorized Agent: ���/Work Phone:
Agent Address: �Q ��/�! �L City: /����j /_/�/ ✓ 1l
State: Zip Code: �i�0[� Agent Email Address:
Escrow Company:
Escrow Address:
State:
Email Report to: I ,�01 Vfi����v _`lldj
Escrow #:
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For Inspection call (Name):
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/1411� Direct Phone:
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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
Date:
Date:VAOZI
Building Division\Forms\ABB 6-15-22
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH