HomeMy WebLinkAboutR2020-0555 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
� 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
RBR#
J._� 2O — 05' ' e www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
AoolicatIon 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: i^,� �� ` � City: Newport Beach State: CA Zlp:ft-?-4�5
State: CA
Zip Code: ZC'
Home Phone: I K,_) 1--t-
Owner's Authorized Agent:
YO���
Work Phone:
Agent Address:
# I City:
State:
Zip Code:
Agent Email Address:
Escrow Company: hCrL Irl` Escrow #: 7�
Escrow Address; C iQLo. I City:
State: Zip Code: Escrow Phone: I C1 qn. 5 Zo• !moi to
Email Report to:
For Inspection call (Name): 1 %3 PT 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: I
OR
Dnausl Dm Dy:
Owner/Agent's signatureto decline inspection: Date: 7�2 2020
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Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
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