HomeMy WebLinkAboutR2020-0953 - Permit ApplicationI � Print ,
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Farm
City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION `10
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8945
RBR# 0 qS3 www.newportbeachca.gov 1 (949) 644-3200 4041'
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
#of Units: Address:
Please type or print and complete all information
City: New-- State: [C—A, Zip: Q—QQO-D
PropertyOwner: Zip Code:
Owner Address:
City:
State: FCA Zip Code:
Home Phone:
Owner's Authorized Agent: Work Phone:
Agent Address:P
city:
State: Zip Code: Fw-�IUQI-a� Agent Email Address: n CA Mn
Escrow Company: Escrow #:
Escrow Address: C��- city:
State: F Zip Code: ff-4tu -c�- Escrow Phone: Z5:�Zpj
Email Report to: Fb—� C-5�,�p 7 C\ �
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 . I ' d aboveunderstand that if Building or Zoning
violations are discovered twill be responsible to correct said violations.
Owner/Agent's signature to authorize inspection: Date:
F—
OR iI
Owner/Agent's signature to decline inspection: Date:
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
Building _DMs1on\FoTms\RBR 7-30-20