HomeMy WebLinkAboutR2022-0100 - Permit ApplicationFlntPoft City of Newport Beach
g,, COMMUNITY DEVELOPMENT DEPARTMENT
r rl/�r) 1 n/) BUILDING DIVISION n'
iCfjV (�(/o V'�10 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
be ret
Reinspection Fee $131.00 or Incomplete will be returned
#of Units: I—
Property
Owner Address;'51—A.o /
State:— Zip Code:
Please type or print and complete all information
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City: Newport Beach State: CA Zip:
City:
jHcme Phone;
Zip Code:
Owner's Authorized Agent:1 /, Work Phone: �—
Agent Address: l.. / (1 _ �C1 City:
State; I ( o - Zip Code: � Agent Email Address: F.
Escrow Company: % /'/C Lloe x/�.cy / —U-{-Escro—w #:
Escrow Address: J U,...../V190-197 C.f:-���vC��/rV}y� City;
State F Zip Coda iJ ?,( Escrow Phone: . �/—
Email Report to:
For Inspection call (Name): Direct Phone: �^
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED B LOWI
I authorize inspections and re -Inspections of the property listed above. I understand that if Building or Zo ning
violations are discovered I will he responsible to correct said violations.
Owner/Agent's signature to authorize inspection:
Owner/Agent's signature to decline inspection:
Account #01050504-521040
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