HomeMy WebLinkAboutR2023-0579 - Permit ApplicationRECENEU BY
COMMUNITY
Print Fonn City of Newport Beach DEVELOPMENT
COMMUNITY DEVELOPMENT DEPARTMENT JUN 2 2 2023
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915 CITY OF
RBR# (LW7-5 061q l www.newportbeachca.gov 1 (949) 644-3200 NEWPORT BEACH
Application for Report of Residential Building Records
Application Fee: - $202.00 Notice:
(For All Residential 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: F71 Address: LZ� -7 i City: Newport Beach State:
Property Owner:
Owner Address:
State: CA
Home Phone:
-I
Owner's Authorized Agent: I Work Phone:
Agent Address: City:
State: �� Zip Code: !� Agent Email Address:
CA Zip:
Zip Code: ��
Escrow Company: � Escrow #: —SO_
Escrow Address I t-t: (} -. (y y,4- Ot- W City: 1
State: Zip Code: q� Escrow Phone:
Email Report to:
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:
Account It 010SO504-521040 .................Make
Building Division\Forms\R8R_6-15-22
CITY OF NEWPORT BEACH