HomeMy WebLinkAboutR2021-0475 - Permit ApplicationPrint Form
City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
RBR# www.newportbeachca.gov 1 (949) 644-3200
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
Please type or print and complete all information
# of Units: /� Address: ? �1 `"�1 �) N 7�t U,� City: Newport Beach State: CA 'Zip: i�
PropertyOwner: CAM;C--Q,90 G;'NCLA((Z
Zip Code:
Owner Address: I%1 L _4 1(,kL A -N -D —A)v. City: v"((/wY'��� ✓r yt
State: CA Zip Code:q'iW Home Phone: [CW -10-3-42
Owner's Authorized Agent:(�/(�NZOS
Agent Address:
Work Phone:
City:
State: F Zip Code: /7�/'2 n,n ��.rr����! ,M
�- UO�lI�.J Agent Email Address: ®(� _�.U(�� all.
Escrow Company: GwpUd� p p�n. I GIS ,9 _.( Escrow #: �jC0(ninrcg��o /-1�'�'S...__
Escrow Address: �.�.:J_\ I APP i..iv..` •... "1- 5....., City: .._I�i%dUi"I:.IN(O"i )� tUv�[:nv(� ........
State:I l/rT Zip Code: FqTGL( Q Escrow Phone: _6Gt Qj
Email Report to: i'�� I I o .4U1%J G�i6�1T�L/4 �GIU \ u
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 or Zoning
violations are discovered I will be responsible to correct said violations.
Owner/Agent's signatureto authorize inspection:
Date:
OR
si��turetodecline inspection: Date:
I �� r
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Building_Division\F.,.s\RBR_7-30-20