HomeMy WebLinkAboutR2021-0226 - Permit Application"Ni City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
�J BUILDING DIVISION
Vr 2�� I 022 100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA92658-8915
RBR# www.newportbeachca.gov(949)644-3200
Application for Report of Residential Building Records
Application Fee: - $194.00. Notice:.
(For AllResidentiat Buildings) Applications with insufficient fee payment
Reinspection Fee $129.00 nr.tncomplete will be returned
Please type or print and complete all information
#of Units: Address: .City:Newport.6eachState: zip:. �a iis-j
Property Owner: ->s
QA Zip Code:
Owner Address: Ka-i._�
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State:CA ___' Zip Code:y i...... Home Phone: _ I
Owner's Authorized Agent: J Work Phone: '.
Agent Address: City:
State: Zip Code: F-71 Agent Email Address:
Escrow
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Escrow Company:
Escrow Address:I�w 1�>0.., OR CY-�4e p- g lty:
State: _L LLD Zip Code: chi ' - Escrow Phone:
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 Building or Zoning
violations are discovered l will be responsible to correct said violations.
Owner/Agent's signature to authorize inspection: Dater
OR
Owner(Agent'ssignature to decline inspection: Date:
J
L7 77
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
B..1ding_Div,w\Forms\RBR 730-20