HomeMy WebLinkAboutR2022-0005 - Permit ApplicationPrint Form City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
qo 2G 600 5 100 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: Address: �Gb W V 1 I 1 b/ A S W V City: Newport Beach State: CA '�,Zip:� ',..
PropertyOwner:
Owner Address: I Wo Wk
State: ICA _ Zip Code: l 11
Owner's Authorized Agent:
Agent Address:
State:I CjI. Zip
Zip Code:
15 �V a % City: GY `V r� A V/ e/ (° 4'/,_ / o yf
`j ✓ Home Phone: �. 9,f jl\
City:
Agent Email Address:
Escrow Company: I [7� ro Gv
Escrow Address: V �%l�l ev r'l �Y ,^
VI V y
State: F Zip Code:
Work Phone:
CGU%� r f7`__ c
Escrow #: I ms .-//
City:�5` (/
Escrow Phone:
Email Report to: I ,���1 \/�'e (I `i/�V�17S0�.. � I y`�/. C�l LU//L � i-_ici'���rlv����/f �L%�(Jl/✓� ���/
For Inspection call (Name): Direct Phbne:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
I authorize inspections and re -inspections ofthe 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: ---
OR
Owner/Agent's sign aturetodedineInspectian: - C / Date:
Account fr U1USUSU4-SZ1U4U .................Make CbeCKS payable t0: CITY OF NEWPORT BEACH
Bullding_Dlvls(.n\Forms\RBR 7-1-21