HomeMy WebLinkAboutR2023-0200 - PermitsPrint Form City of Newport Beach REC IIIED By
P DEVELOPMEN
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION A14 14 2023
100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA92658-8915
RBR# le-�o�✓` 0 40l> www.newportbeachca.gov (949) 644-3200 CITYO'
NEWPORT BEACH
Application for Report of Residential Building Records
Application Fee: - $202.00 Notice:
(For All Residential Buildings) Applications with insufficient fee payment
Reinspection Fee $134.00 or incomplete will be returned
Please type or print and complete all information
# of Units: Address: 0 City: Newport Beach State: CA Zip:
Property Owner: �Zip Code:
Owner Address: 6 1� W. G � City: FV-oo- &_Ce-h
State: CA Zip Code: Nome Phone: �q..�?j —� [ o
Owner's Authorized Agent: Work Phone: F
Agent Address: City:
State: Zip Code:— Agent Email Address:
Escrow Company: -- -11 i Escrow #: Sty` TTLI
Escrow Address: IZbb Mao-4- Or- 1 City:
State: P A Zip Code: Z Escrow Phone: Lf ll'L
Email Report to:
For Inspection cal
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
Date:
Date: 131 7 1-1 -)
Account # 01050504-521040
Bui Iding_ Division\Forms\RBR_6-15-22
........Make checks pavable to: CITY OF NEWPORT