HomeMy WebLinkAboutR2023-0584 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8 5
RBR# V-ZO7,7 - 05 $ C` www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
RECEIVED BY
COMMUNM
DEVELOPMENT
JUN 2 6 2023
CITY OF
MIMI RT BEACH
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: City: Newport Beach ] State: CA Zip:
Property
Owner Address:
State: CA
Owner's Authorized Agent: Work Phone:
Agent Address: City:
State: F777� Zip Code: F--7 Agent Email Address:
Zip Code:
Escrow Company: Escrow#: FOS5-97f-1 (-
Escrow Address: City:
State: FcTi�-- Zip Code: Escrow Phone: _q r- 6. I/ '�3
Email Report to:
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 are discovered I wi II be responsible to correct said violations.
Owner/Agent's signature to authorize inspection:
Owner/Agent's signature to decline
Date:
Date:
8ui1din�Divi5ion\Forms\RBR_6-15-22
Account It 010SOSO4-S21040 .................Make checks payable to: CITY OF NEWPORT BEACH