HomeMy WebLinkAboutR2020-0314 - Permit ApplicationPrint Form City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
RBR#11-
i (/ , www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
Application Fee: - $191.00 Notice:
(For All Residential Buildings) Applications with insufficient fee payment
Reinspection Fee $129.00 or incomplete will be returned
PropertyOwner: 7� (� n._-9.,-L�/�(Q- _-_ -_ l I_y///JZip Code:l,Q,l.
Owner Address: �.V0 LullI�_ _ -.- ,--,w, -City:
State: CA Zip Code. �'(Z�1Q� ! Home Phone
Owner's Authorized Agent: i Work Phone:
Agent Address: City:
State: F Zip Code. F Agent Email Address:
Escrow Company: . - C1 ........ -...._ _..._....1 Escrow #:
Escrow Address: � city:
`f�v
State Zip Code: gZN0
, V'C.•Essccrrof w Phone:
I
Email Report to:
For Inspection call (Name): Direct Phone: _I
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:Y"
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
Building Division\Forms\BBB 9-18-18
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PropertyOwner: 7� (� n._-9.,-L�/�(Q- _-_ -_ l I_y///JZip Code:l,Q,l.
Owner Address: �.V0 LullI�_ _ -.- ,--,w, -City:
State: CA Zip Code. �'(Z�1Q� ! Home Phone
Owner's Authorized Agent: i Work Phone:
Agent Address: City:
State: F Zip Code. F Agent Email Address:
Escrow Company: . - C1 ........ -...._ _..._....1 Escrow #:
Escrow Address: � city:
`f�v
State Zip Code: gZN0
, V'C.•Essccrrof w Phone:
I
Email Report to:
For Inspection call (Name): Direct Phone: _I
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:Y"
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
Building Division\Forms\BBB 9-18-18