HomeMy WebLinkAboutR2022-0088 - Permit ApplicationPrint Foam City of Newport Beach COMMUNITY
COMMUNITY DEVELOPMENT DEPARTMENT L'EVELOPMENI.
BUILDING DIVISION FEB 24 2022
FI�I�1-
Z I1f� �'(( 100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA92658-8915
3R# c VU o www.newportbeachca.gov 1 (949)644-3200 yylTYOF.
Application for Report of Residential Building Rece4o%pT 600`1
Application Fee: - $198.00 Notice.
(For All Residential Buildings) Applications with insufficient fee payment
Reinspection Fee $131.00 or incomplete will be returned
Please type or print and complete all information
# of Units: Fri Address: D it . ewport Beach I State Zip:��
Owner Address:
State: CA - -- Zip Code:
City:
Home Phone:
Zip Code:
Owner's Authorized Agent: Q Work Phone: Z
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Agent Address: ti�V U 8_...Aek \'-�---_�✓-- J City:.......
State: �� Zip Code: � Agent Email Address:
Escrow Company:
Escrow Address:
State: Zip Code:
Email Report to:
For Inspection ca
..._... ___ Escrow #:
City:
Escrow Phone: R/
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
I authorize inspections and re -inspections of the property listed above. Iunderstand that if Building or Zoning
violations are discovered l will be responsible to correct said violations
Owner/Agent's signature to authorize inspection:
OR
Owner/Agent's signature to decline inspection:
BuIldIn�Division\Forms\RBR 7-1-21
Date:
Account It 01050504-521040 ................. Make checks payable to: CITY OF NEWPORT BEACH