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HomeMy WebLinkAboutR2020-0514 - Permit ApplicationPint Form City of Newport Beach COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915 RBR#JF-ww�— bs> � q 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 # of Units: F— Address: s Property Owner Address: State: CA Owner's Authorized Agent: Please type or print and complete all information rintin ©01Q' 1 /I Zip Code: C,Jcity: Newport Beach State: CA Zip: Zip Code: city:�,��;�. t l L./T- Home Phone: yo—T/ Agent Address: City: State: F— Zip Code: F Agent Email Address: Work Phone: Escrow Company: I 1" J\ /a r (fin �n�n ,S1 �i�cu) Q1 fPQ /-Cct 14scrow #: Escrow Address: /�� � (J4 V u{J C()/ { (2 O -�. `��Ittyy IV 4--o plo1�—I . pGi�_ State: Gy�� Zip Code: � („ O "`'mac je c�0 Escrow Phone: q , i 7J C� . a i 13 Email Report to:T I For Inspection call (Name): ' ,yDr I r) 46 X cru.C.�— Direct Phone: CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOWI 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 correctsaid violations. Owner/Agent's signature to authorize inspection: Date: OR Owner/Agent's signature to decline inspection: Date: Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH Building Division\Forms\RBR 9-18-18