HomeMy WebLinkAboutR2022-0025 - Permit Application-777771
City of Newport Beach
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COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
0 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915�(/N
RBR# ��O���O" www.newportbeachca.gov 1 (949) 544-3200
Application for Report of Residential Building Records
Application Fee: - $196.00 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: 73 -12 -Ci Newport Beach ' State: CA Zip: a 2�� �
Property Owner. Vo `tt\ i _ Zip Code: /?2(060 l
Owner Address: l'l h !°'r R ;#- /-'ty-v
\(J City: ` l l r
State: CA Zip Code: [r 0 Home Phone:
Owner's Authorized Agent: 1, ,1� ` Work Phone:
Agent Address: Lll� /',�N+ /C-ctijt city:
State: T Zip. Code: Fe -
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Agent
�� Email Address:
Escrow Company:
Escrow Address:
State: I C N.
Escrow #:I 1 /mid 3
.. � ce f tr- city: F. 1,36
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Zip Code: ! ,-i- nl Escrow Phone: ' q{ 11 -7
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Email Report to: 1
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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 orZoning
violations are discovered I will be responsible to correct said violations.
Owner/Agent's signature to authorize inspection:
Date:
OR
Owner/Agent's signature to decline inspection 7 � _ __ Date:
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