HomeMy WebLinkAboutR2020-0893 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
144vic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
RBR1j70eV' www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
Application Fee: $291.00 Notice:
(For All Residential Buildings)
Reinspection Fee $ 129.00 ApplicationsWith insufficient fee payment
or incomplete will:be returned
Please type or Print and complete all information
#of Units: F— Address: I -W— City: Newport Beach - State: [CA -1,ZIp:F9 _9QW QC0 —C I F
Owner Address:
State: lcA-. Zip Code: I N 1 -
Owner's Authorized Agent:
Agent Address: 0State: F Zip Code:
Iff
>ee Zip Code; F777
City:
-- -- -----------------
Home Phone: [1\ [
Escrow Company: Escrow #;
Escrow Address- city: FN5 --- C --h --
State: FM I q2,
r Zip Code: U D Escrow Phone: k7fq— 53 9 72q L3
Email Report to: 0rvel ( —C- +--e
For In I ame); N \-j I Direct Phone:
... ... ...... ...
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
I authorize inspections and re -inspections of the property listed above.) understand that if Building or Zoning
violations are discovered I will be responsible to correct said violations.
Owner/Agent's signature to authorize inspection:
Owner/Agent's signature to decline inspection:
Account # 01050504-52104D
Buliding_DNision\Fom$\RBR_9-18.18
Date:
Date:
rhprkc na.hlc m. rnwnr AlrlfilDnDTDCAr.