HomeMy WebLinkAboutR2021-0066 - Permit ApplicationPrint Form City of Newport Beach :�Y-OaIVC[),6k
COMMUNITY DEVELOPMENT DEPARTMENT COW4UNITY
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-89110,N 2 0 RECD
RBR4 www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Recorcfs�- 0Z
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: 7, �5Address: u� city: Newport I irach j State: [CA � Zi p:
Property Owner:Zip Code:
Owner Address: City:j.
State: 7.1 FE
F I Zip Code: Home Phone:
Owner's Authorized Agent: Work Phone: 1P) UL[b
Agent Address: city:
State: Zip Code: Agent Email Address:O.Z�A
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Escrow Company:Escrow #:I
...... .. . .
b\(�- ro, city:
Escrow Address:
Zip Code 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 orZoning
violations are discovered I will be responsible to correct said violations.
Owner/Agent's signature to authorize inspection: Date:
Owner/Agent's signature to decline inspection: W Date:F I �Qec-rt
Account # 01050504-521040 ................. h4W checks payable to: CITY OF NEWPORT BEACH
9u]1d1ng_NVidon\Fcrms\RBR 7-30-20