HomeMy WebLinkAboutR2022-0039 - Permit Application�E,CEIVE4 �,�
COMMUNITY
City Of Newport Beach DEVELOPMENT
COMMUNrrY DEVELOPMENT DEPARTMENT
BUILDING DIVISION JAN 2 5 2022
100 Civic Center Drive I P.O, Box 1768 1 Newport Beach, CA9265"915
RBR# - www.newportheachca.gov 1 (949) 644-3200 CITY OF
Application for Report of Residential Building Records +-'�OfnT 9�;
,400fimtion F'ee:::-$: �.qg . • Notices;
. (�or'AIL4z'esideritiaLBui{dings)' Appticationswith.rnseffcient•fgepegment
Rernspecdon-F.ee:$A29OD: orcin-ori9plete will:lie;iieivrned:
Please type or print and complete all information
# of Units: I 1 I Address: qty: Newport Beach State: CA Zip:—T—)
6f o•
Property
Zip Code..
Owner Address:
State: C
Owner's Authorized Agent:
Agent Address:
Work Phone:
City:
State; Zip Code: Agent Email Address:
Email Report ta:
For Inspection call (Name): Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED SELOMn
Paatharize Inspectronsand reAnspect{on'softhe property tilted above, l understandthat.rf B'giidingorZoning,
vralationsare discovered:) will be: resp\insihl'e.to correctsad'd viblatiDns.
Owner/;Agents signature•toauthaniie inspec6iam:
fiWImnLONYIon\Foams\R9P 9-09-]8
Date:..
—
Date: '.^'L7' Q•i J
Account # 01050504-521040 .................Make checks payable ta: Cl7Y OF NEWPORT BEACH