HomeMy WebLinkAboutR2021-0269 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
j(I 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
RBR# d. U (,U! www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
- Application Fee:: -$191.00. Notice::
(For AlIlResrdential.Buildings) - Applications: with .insufficient feepayment
Reinspection Fee: $:129.00: or incomplete will. be: returned
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Owner's Authorized Agent:
Escrow Company:
Escrow Address: I 1 / 00
Email Report to:
For Inspection call (Name):
Agent Email Address:
Work Phone: I W— -�%0 j) I
Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
I authortze inspections.and.re=inspections of, the property listed above. I understand that.rf BglldingorZoning.
violations are. discovered'I will be.responsible.to correct sa:id viiolations.
Owner/Agent:ssignature to authorize i;nspectian:
Date:
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Owner/Agent'ssignature to decline inspection,: Date:.
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
BuI1tlN�riv6ion\Fo,ms\flflP 9-18-18