HomeMy WebLinkAboutR2021-0465 - Permit ApplicationCity of Newport Beach
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COMMUNITY DEVELOPMENT DEPARTMENT COP�71�4UNI'iY
BUILDING DIVISION
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100 Civic Center Drive � P.O. Box 1768 � Newport Beach, CA 92658-8�1� -
RBR# www.newportbeachca.gov 1 (949) 644-3200 JUN 2.12021
Application for Report of Residential Building Records
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Avplicatibn Fee -$1,91.00' - - Not¢e:: 7ti - h.
(tor All. esBdenttal.Buiidings) A lications with. insuffi ie�, P PG
pp BiY`Tie payment
Reinspection Fee:$:129.00: orincortBpietewill.be: returned
Please type or print and complete all information
# of Units: Address: O �' I City: Newport Beach. State: Zip: Zt7Z5
Property
Zip Code:.
Owner Address:
State:
Home Phone: QLP ^ pl
Owner's Authorized Agent: Work Phone: 190
Agent Address:
City:
State: '_^�"' ] Zip Code: ' Agent Email Address:
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For Inspection call (Name):
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
I authorize inspections.and.re=inspections pfthe property listed above. I understand that.if Building or Zoning.
violations are.discovered I wizfbe:responsibl'e.tocorrect said violations.
Owner/ApriVssignature'to authorize. inspection:
Date:.
.I.
OR
Owner/Agent'ssignature to decline inspection: Date:. J
Account # 01050504-521040 .................Make checks payable to: CITYOF NEWPORT BEACH
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