HomeMy WebLinkAboutR2022-0001 - Permit Application,�.eCeIVED 6y
COMMUNITY
Print Form City of Newport Beach !DEVELOPMENT
COMMUNITY DEVELOPMENT DEPARTMENT JAN 0 3 2022
BUILDING DIVISION
�20�'l,000 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658,$..?� 55
RBR# www.newportbeachca.gov 1 (949) 644-3200 OF
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Application for Report of Residential Building Records "'
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: Address. Jp-ue bao—A Valle.t II City: NewporCBeach State: CA Zip:
Property Owner] Mai itv 1n,k4 ae, --ei( �jG(.-YrlLl Zip Code:
lei I I I Yus
Owner Address: City:
State: CA Zip Code: Home Phone:
Owner's Authorized Agent: i(y) Work Phone:
Agent Address: UD ,—WVw+ Catev 'L't -�-1010City: 1u, or' R;,'-ttd)
State: ( Zip Code:=3-ft?ik'U Agent Email Address: t,
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Escrow Company: `Lie. R(JZI ku Escrow #:
Escrow Address: etv lv `'14-5 City: Drj R)QLich
State: Zip Code: Escrow Phone: I C1 Wl— L(l q --I Cil)iJ
Email Report to: LJUSnn C` Ur LV(!. Waj—Pr„('SC iL.0-CXR
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 signature to authorize inspection:
Date: I
i OR
Owner/Agent's signature to decline inspection:,`�y��� Lin ,�lr�l�pate: ;-�- -AL1 �-
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
Building Division\Forms\RBR 7-1-21