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HomeMy WebLinkAboutR2023-0620 - Permit ApplicationCity of Newport Beach COMMUNITY COMMUNITY DEVELOPMENT DEPARTMENT DEVELOPMENT BUILDING DIVISION II l 1 Z()23 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92 15 RBR# f-7-VZ,3 ^ 06 Z'o www.newportbeachca.gov 1 (949) 644-3200 CITY OF NEWPORT 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 #of Units: K Address: G1 City: Newport Beach . State: CZip: Property Owner: �,� Zip Code: I (1 Owner Address: BY�� aCity:(L) State: CA Zip Code: I �c Home Phone: Owner's Authorized Agent: Agent Address: Work Phone: ''.. City: State: Zip Code: Agent Email Address: Escrow Company: ;7� r, 04 FCCADuO Escrow Escrow Address: , �� N�p��— City: W 6 State: v� Zip Code: 4'2 (Q Escrow Phone: y G' 3�35 Email Report to: �Nn©(� d1 QeC1D/�I QSGt2i_ rr�VVL C IriQ(x01/V)C ft)to.C()m 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 signature to authorize inspection: Date: OR Owner/Agent's signature to decline Date:4 Arrnunt d 010SOSn4-5➢1040 _..._..._....Make checks oavable to: CITY OF NEWPORT BEACH Building Division\Forms\RBR_6-15-22