HomeMy WebLinkAboutR2020-0486 - Permit ApplicationPrint For City of Newport Beach rc=1VE� �L
COMMUNITY DEVELOPMENT DEPARTMENT COM OUNITY
BUILDING DIVISION Dr---VEi OPMENT
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA9265$j9�1 Z�ZQ
RBR# Y� 2-�J C`� qdb 1.3www•newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Recordf'IIYO
Application Fee: - $191.00 Notice: R%nOR.t_
(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: Fl Address: CnfoYliA G _- City: Newport Beach I State: CA (Zip: Uia(6.I_
PropertyOwner Morr.i_I)__TYVS-� -_._ - .l Zip Code:
Owner Address: (� i�Y ih�i GP Cit
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State: CA -...._._ Zip Code: 75� -__ __- Home Phone ........._.___----- -._._...._ _..._-
Escrow Company:Y �CYCrJ ......-_ _ _,
�, c` j Escrow #
Escrow Address: Qf}
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State:: ��, Zip Code Escrow Phone:
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Email Report to:'�
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 inspection:A�� Date:
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
Budding Division\Forms\RBR_9-18-18