HomeMy WebLinkAboutR2023-0393 - Permit ApplicationRECEIVED BY
COMMUNITY
City of Newport Beach DEVELOPMENT
COMMUNITY DEVELOPMENT DEPARTMENT h AY 0 4 2023
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915CITYOF
Bsia# (L2oZzl 0313 www.newportbeachca.gov 1 (949) 644-3200 NEWPORT BEACH
Application for Report of Residential Building Records
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: IE Address: In 5 �q) E4,/Q City: Newport Beach State: FZip:
P roperty Own r:Wam, Naxlw4, Zip Code:
Owner Address: ) Ylb C City:
State: CA Zip Code: '-- 6 Home Phone:
Owner's Authorized Agent: Work Phone:
Agent Address: City:
State: Zip Code: Agent Email Address:
Escrow Company: Escrow
Escrow Address: I�_j" City:
State: � Zip Code: � 1i1 Escrow Phone: "G / tCy�1x `I I'y- c
3 , /
Email Report to: l%nPQr�1 .1�1 �lescA-)w,(_oyn
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 responsible to correct said violations.
Owner/Agent's signature to authorize inspection:
Owner/Agent's signature to decline
Date:
Date:
Bui 6d ,Divw.i %Forms\RDR_6-15-22
Account it 01050504-521040 .................Make checks payable to: U I Y OF Nt WPUHI BLALFI