HomeMy WebLinkAboutR2020-0325 - 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#✓ ��� - 0 �Z-S www•newportbeachca.gov (949) 644-3200
Application for Report of Residential Building Records
Application Fee: - $191.00 Notice:
(For All Residential Buildings) Applications with insufficient fee payment
Reinspection Fee $129.00 or incomplete will be returned
Please type or print and complete all information
# of Units: 1 Address: �'I I City: Newport Beach 1, State: CA Zip: `NU11
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PropertyOwner: (nn � I. n _twhAM .A �1�/) 610 .-V, i'..{I (aMslTmST�Zip Code: F I
Owner Address: "• ," 1 �G City: v y
State: CA Zip Code: Home Phone:
Owner's Authorized Agent �I w- _. Work Phone:
Agent Address: U City:
State:
F_—', Zip Code: Agent Email Address: V1 (a��a b►'arv15COGS-Q.•. V"' '
Escrow Company: �F�j�,i? wl (E�jc,,/W �_.I,.... (�� __...... Escrow #: '(U�siLo1 5- T�
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Escrow Address: L1N� IJU''t...&a-L _. V. �DIJ City:
State:', Zip Code: G1..1161-t.V. Escrow Phone:
Email Report to: U e . CSC -y U" U/1 1 . _ &f 1 VM -
For Inspection call (Name): t�/1 Direct Phone:
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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 inspection: kh;((p Date: I 3)1 )026
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
Building Division\Farms\RBA 9-18-18