HomeMy WebLinkAboutR2023-0324 - Permit ApplicationYED gV
City of Newport Beach CO �WM Nl
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION R 2 2�23
100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA92658-89f5
l42-0 Z 3 www.newportbeachca.gov (949) 644-3200 OF
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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: I) Address: f I I (`� City: Newport Beach
... State: CA Zip:
Property
Owner Address:
State: CA I
Phone:
Owner's Authorized Agent: Work Phone:
Agent Address: City:
State: F77-71 Zip Code: Agent Email Address:
Escrow Company: _ Escrow
Escrow Address: lzob City:F.
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State: Zip Code: L-�1 Escrow Phone: Y q— j
Email Report to:
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 or Zoning
violations are discovered I will be responsible to correct said violations.
Owner/Agent's signatureto authorize inspection:
Owner/Agent's signature to decline
Date:
OR
Date: ZQ 2t3
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