HomeMy WebLinkAboutR2021-0171 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
yl n `n 1 t^ 1 DO Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
RBR# '� �(J l•� 1 www.newportheachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
Avpiication Fee::-$pim, - Notice:;
_ '(FocAll!Residential.Buildings) - Applicationswith.insuffcientfee payment:
Reinspection F.ee:$;129:00 orincomplete will .be: returned.
Please type or print and complete all information
#of Units: Address:15N9 Yj(yr� City: Newport Beach State: CA Zip:
Owner's Authorized Agent:
Agent �rAdd�resss:I
State: Zip Code:
Escrow Company:
Agent Email Address:
Work Phone:
EL
ILI .. ri _ 1I WOWAM [l/12
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
I authorize inspections.and.reAnspections of property fisted above. I understand that.if BuAdingorZoni:ng.
violations are.discovered I will be:responsible.to correctsa:id violations.
Owner/AgenVssignature'to authorise Inspection: Date: I
OR
Owner/Agent.'ssignature to decline. inspection:
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
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