HomeMy WebLinkAboutR2021-0251 - Permit ApplicationPrint Fo» City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
RBR# U / www.newportboachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
Apalication Fee: -$194.00 Notice:
(For All Residential Buildings) Applications with Insufficient fee payment
Reinspection Fee $129.00 or Incomplete will be returned
Please tv or int and comtrlete all information
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ownerAddress
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Owner's Authorized Agent: I� Z( L, Y t �h I j�\prY1, Work Phone: , y - ` (r7 q�y�
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Escrow Company: I C rl 1[,.-S C�a� Escrow ir:rr01�y�'2
Escrow Address 202 GbO4 7_4---JtZ(o . City::..
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For Inspection call (Name): ( Direct Phone:
CONSENT TQ INSPE�(T FOR STBE SIGNED &DATED 9ELOV...11,)..
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:
AM
Owner/Agent's signatureto decline inspection: Carolyn P. Roskowski
9NICinB E1I1R1..\Fmm1\RBR 7-30-20
Date:
Date:[ _ 04/05/21
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