HomeMy WebLinkAboutR2020-0483 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
RBR# C-(CbS vtww.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: City: Newport Beach State: CA Zip:
F-7 I C.3�,STI
Property
Owner Ac
State: FC Zip Code:
Zip Code
City:
Home Phone:
Work Phone:
Owner's Authorized Agent: m 0--)
Agent Address: city:
State: Zip Code: Agent Email Address:
Escrow Company:2 Val j
LVEscrow #: A 00 v X
Escrow Address: N . A City:
State: -----
I Zip Code: Escrow Phone: t 7L*
Email Report to:
. ... .......
— --- — ---------- --- - _L...
For Inspection call (Name): Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
I authorize inspections and re -inspections of the property I isted above. I understand that if Building orZoning
violations are discovered I will be responsible to correct said violations.
Own er/Agent's signature to authorize inspection: Date:
OR
1�—
Owner/Agent's signature to decline inspection N Datebb 2-0
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
Buildin�Division\Forms\ROR 9 18-18