HomeMy WebLinkAboutR2022-0003 - Permit ApplicationPrint Form City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
tnn Wll,M 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: - $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: RD Address: 0011 I� S \ S ` City: Newport Beach State: CA ',. Zip: F1aWS
PropertyOwnera \--�JIA) �. �.. `F'�'� ��
Zip Code:
Owner Address: _ `1 l 0�. (� City:
State: CA Zip Code: r Home Phone:
Owner's Authorized Agent: Work Phone: �—
Agent Address: City:
State:— Zip Code: F Agent Email Address:
Escrow Company: \ Escrow #: O
Escrow Address:City :
I'La U N ey��. r a— ('YtiL-•- ��'•
State: Code. Z'/2(�(,� ',. Escrow Phone:
Email Report to:f� J
�-rir.C�L1,nn.2SCrYl�.l. ' LOf',1. _. ..
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:
Owner/Agent's signature to decline inspection:
Building Division\Forms\RBR 7-1-21
OR
Date:
Date: 12
Account # 01050504-521040 .................Make checks novable to- CITY OF NEWPORT RFACH