HomeMy WebLinkAboutR2020-0831 - Permit ApplicationPrint Form
City of Newport BeachFp
COMMUNITY DEVELOPMENT DEPARTMENT D 2PS/%FCO
BUILDING DIVISION c 6LFY
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92c,68-8$sNr
RBR# www.newportbeachca.gov 1 (949) 644-3200 4'F4aORT 6EPG�
Application for Report of Residential Building Records
Application Fee: - $194.00 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: ��j A 0}QyL Cit New art Beach State: CA ',i Zi C
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Property Owner:
Owner Address: ,q.PO�R.V.D, AVC. __.._ ! City: �1,..._S�G+^ _
State: CA Zip Code: qh;OHome Phone:
Owner's Authorized Agent: Work Phone:
Agent Address: 1 City:
State: F i Zip Code: F Agent Email Address:
Zip Code.
Escrow Company: �{ Qg. p\m G Clfu* Escrow # o SI"ibJ Ll a - W
Escrow Address: I m1 r,�-i-��! City: ..._
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State: FCA _. Zip Code: %460 Escrow Phone: q�(I
EmailReportto:
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:
Owner/Agent's signature to decline inspection:
Building_Division\Forms\RM 7-30-20
Date:
OR
Date: -y]-:o
Account # 01050504-521040 .................Make checks payable to: CITYOF NEWPORT BEACH