HomeMy WebLinkAboutR2020-0305 - Permit ApplicationPrint Form City of Newport Beach ,,�SCEIVC-o a�
COMMUNITY DEVELOPMENT DEPARTMENT COMMUNITY
UEVEI_OPMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658VM!2 3 2020
RBR# YG(/GV •V �www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Recor.o i:ITY (fir
'• AOr?r SFP
Application Fee: - $191.00 Notice:
(For AIIResidential 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: 2.,W10 rvfl�r� L� _ City: Newport Beach State: CA _IZip:F
Property
Owner Ac
State: CA Zip Code:
Home Phone:
Owner's Authorized Agent. 1(liOLY1Yl�. fn., Work Phone:
Agent Address: 'v� City:
State: Zip Code: F Agent Email Address:
Zip Code: F
Escrow Company QQ'jj�� Escrow #:
Escro
State: Zip
Address. Zip Code o ' Uv City: Escrow Phone:
h l e U 4q- 3CA
l _.__...__..._.
Email Report to:
For Inspection call (Name):
Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
6A,ems
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 signature to decline inspection: Id Date:
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
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