HomeMy WebLinkAboutR2023-0464 - Permit Applicationflrsial�e COMMUNITY
" RECEIVED By
City Of Newport Beach DEVELOPMENT
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION MAY 2 6 2023
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-
www.newportbeachca.gov 1 (949) 644-3200 WO
NEWPORT BEACH
Application for Report of Residential Building Records
Application $202.00
(For All Residential Buildings) Notice:
Reinspection Fee $134.00 Applications with Insufficient fee payment
or Incomplete will be returned
#ofunits: FT Address:
Property
Owner Address: I l/,z
State: F777-71
Zip
Owner's Authorized Agent
Please type or print and complete all Information
i
City:
City: Newport Beach State: CA Zip: 2 c/'
Zip Code:'=` -� J
Home Phone:
Work Phone: j
Agent Address:
---- __ City:
State: Zip Code:
Agent Email Address:
Escrow Company:
Escrow Address:
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State:
Email Report to:
For Inspection call (Name):
City:
Zip Code:
JEscrow #: T55 -
Escrow Phone:
Q n �P 7 —✓
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: I�----
Date:l
Owner/Agent's signature to decline
Date:
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
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