HomeMy WebLinkAboutR2021-0569 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
R13RO www.newportbeachoa.gov 1 (949) 644-3200
Application for Report of Residential Building Records
Please type or print and complete all information
#of Units: Address: 1. City: F—", State: r
;Zip:
Beach A
Property
Owner Address:
State: IC Zip Code:
Zip Code:
City:
j
Home Phone:
Owner's Authorized Agent: Work Phone;
Agent Address
City]
State: Zip Codee j Agent Email Address:
Escrow Company: Escrow #: (j
Escrow Address:! city:
State: 1j Zip Code:,.Escrow Phone: 1-,1114
Email Report to:
For Inspection call (Name): I I Direct Phone: I I
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 I will be responsibleto correct said violations.
Owner/Agent's signatureto authorize inspection: Date:
OR
Owner/Agent's signatureto decline inspection: Date:
-2 0 Zf
Account # 01050504-521040 .................Make checks payable to: CITYOF NEWPORT BEACH
Building _DM,1.n\F.1.s\RBR 7-131