HomeMy WebLinkAboutR2020-0315 - Permit ApplicationPrint Form
City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 CCenter Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
RBR# 9I 0-0317 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
Please type or print and complete all information
#of Units: Address: l.�(.{ �� -_ City: NewportCMSi-! State: CA Zip:
Pro ert Owner: l i .. .. .../--1 � � .__..__...: Zi Code. 20`7
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Owner Address:(,'. - -... City: -..1
State: CA Zip Code: Home Phone
Escrow Company: Escrow #:
Escrow Address: _ U _., city:
State: „..IT=�li Zip Code: �2Late � Escrow Phone: -_--(„�(�. l QL(. Sol 9,q .. .._
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:
Date:
Owner/Agent's signatureto decline inspection: (}ytoA�,U, �,. 4zjZ•�.�
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
Bunding_DM,m\Form,\FBR 9-1816