HomeMy WebLinkAboutR2023-0623 - Permit ApplicationPrint Form City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA92658-8915
RBR# 9-ZO2_3 - O (,'L °> www.newportbeachca.gov (949) 644-3200
Application for Report of Residential Building Records
L 11 Z023
CITY OF
NEWPORT 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: Q
rop�rty 0 �5 I �- Zip Code:
Owner Address: I �'� ity:
State: CA Zip Code: Home Phone: -11q
Owner's Authorized Agent: Work Phone:
Agent Address: Rn D.� i f �- 'l y:
)UD
State: F 2,WZip Code:eX C
Escrow Company: (2'1r� 1�3 Escrow #: Kb
Escrow Address: C,0 0(t �� �'� I` )DO city: � --?>e_v� �Y
State: F-5N7 Zip Code: ��-(p (p Escrow Phone:
Email Report to: P^�[�.S GCi � , +LI G5G5cy-o(l.Gt)y" I l I 1
For Inspection call (Name): ((h t�JC"a+ ���J1L��Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW) • 4 I
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
Owner/Agent's signaturg to decline
Date:
Date: b �a7
Account # 01050504-521040 .................Make
Building _Division\Forms\RBR_&15-22
aavable to, CITY OF NFWPORT RFA[H