HomeMy WebLinkAboutR2021-0225 - Permit Application=Frl orrm City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
dot /rn22� 100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA 92658-8915
RBR# U www.newportbeachca.gov (949) 644-3200
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. r, No- P1a(� City: Newport Beach! State: CA_Zip: C17�PC93
Escrow Company:Escrow #: - 4l
Escrow Address: F c,+ p eI,�J J City: S (4 /qA a n i
State: FTT Zip Code: q2E' p 1 _ - -1 Escrow Phone: '7114..- 2SD- LjooL�(
Email Report to:
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
violations are discovered l will be responsible to correct said violations
uildingorZoning
Owner/Agent's signature to authorize inspection: Date:
OR
Owner/Agent'ssignature todecline inspection: \ Y Date:
Account # 01050504-521040 .................Make checks payable to: CITY OFNEWPORTBEACH
BWlding Division\Forms\R3R_7-30-20