HomeMy WebLinkAboutR2023-0243 - Permit ApplicationRECEIVED BY
City of Newport Beach COMMUNIV
DEVELOPMENT
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION MAR 2 7 2023
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
V—ZOZ 3 —OZy 3 www.newportbeachea.gov 1 (949) 644-3200 CITY Of
NEWPORf 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
It of Units:F171 Address: I f2-L& City: Newportac Beh CA State: Zip:
PropertyOwner:
Owner Address:
State: CA
Zip Code: 17NY2,
Home Phone: / M- j��7
Owner's Authorized Agent: Work Phone:
Agent Address: City:
State: Zip Code: Agent Email Address:
Escrow Company: IO Escrow #: S✓ j
Escrow Address: 12n)%4VA of Dry G � City:
State: � Zip Code: 'f-��p4 Escrow Phone: L P•'il!'"1—j / 3
DirectEmail Report to: ff"W=An M11
tj
For Inspection call (Name): =
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 a re d iscovered I wi II be responsible to correct said violations.
Owner/Agent's signature to authorize inspection:
OR
Owner/Agent's signature to decline
Date:
Date:
Account # 01050504-521040 .................Make checks
Buildm�Division\Forms\RBR_F15-R
to: CITY OF NEWPORT BEACH