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HomeMy WebLinkAboutR2023-0694 - Permit ApplicationRECEIVED By Print Form City of Newport Beach COMMUNITY COMMUNITY DEVELOPMENT DEPARTMENT DEVELOPMENT BUILDING DIVISION JUL 2 6 2023 n 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915 RBR# R2flZ3 OCD c1 www-newportbeachca.gov 1 (949) 644-3200 CITY OF NEWPORT BEACH Application for Report of Residential Building Records Application Fee: - $202.00 Notice: (For AIIResidential 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: Property Owner Address: Z .S State: CA Zip Code: (/ Home Phone: Owner's Authorized Agent: Work Phone: �— Agent Address: City: State: Zip Code: Agent Email Address: [CA Zip: l `t/J'� In7 Zip Code: Escrow Company: Ln/Y��/�/� 6 F-,5cA%,�- 1 Escrow #: G 1 Escrow Address: /M rjVbV/)U&04 ` C City: State: I Er^` Zip Code: �Zle�/,/, Escrow Phone: p�f9 [fi grg - Email Report to: I (�t"N 2k ©ty\e SCXO ( 97 co-, , - )U) (&(., -�Y✓1� �{'��L-Q� fi��l//'..... 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: O Owner/Agent's signature to decline (.. Date: Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH Budding_Divisicn\Farms\RBR 6-15-22