HomeMy WebLinkAboutR2021-0809 - Permit ApplicationPrint Form
City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
PL/1 n /COQ 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
RBR# � 14 �I (J 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 ��i } Y )SC\l��t- t ft�{, city: NewportBeach State: CA Zip: At
Property Owner: f ')CA�aVIOe � r It✓vl, ` Zip Code: ��j �Q�
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Owner Address: i Gi )-� i�l`�G 1 1 i (� �;"'(�In'�i City:
State: CA Zip Code; q �. wo Home Phone:
Owner's Authorized gent:1 l�
Work Phone: , ?74) , C9
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Agent Address: Ip9 Ui�xtlirl.�Y�;, City:
State: Zip CoderLIPAgent Email Address: L�Gt]CGX�1 ( C�0,0,)
Escrow Company: �) Escrow #: j� Z
Escrow Address: !-C V L"'V hCU Ll o i) to City: (?I''bu- L) Ii i::A
State: CI� Zip Code: Escrow Phone: �,7-1 rD ' 1 , � Y
Email Report to: ) V0 -a- 'Yc GI CCi l V=1i�Vt' ��1�.�'i�`.,.�'i.�._(.� I L: f -?"-I J
For Inspection call (Name): �)hbl Li -K LA ' Direct Phone: �-)� ��.� , q 7-0 71
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
I authorize inspections and re -ins
violations are discovered I will be
Owner/Agent's signature toautgorizeinspectio /'
Owner/Agent's signature to decline inspection:
Building Divisian\Farms\RBR_7-3D-2D
.ted above. I understand that if Building or Zoning
violations.
Date:
Date:
Account # 01050504-521040 ................. Make checks payable to: CITY OF NEWPORT BEACH