HomeMy WebLinkAboutR2020-0542 - Permit ApplicationOEIVED 6y
COMMUNITY
PnrtUrm City of Newport Beach DEVELOPMENT
COMMUNITY DEVELOPMENT DEPARTMENT JUL 0 12020
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA 92658-8915
RBR#� www.newportbeachca.gov (949) 644-3200 CITYOF
Application for Report of Residential Building Recor&Wf'ORT 5f V'
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 /] / /
It of Units: �,_ Address: '%� 1�� _ City: Newport Beach State: CA _Zip:._ vta t-('V�
Property Owner:_
Owner Address:
State: CA
Owner's Authorized Agent:
Agent Address: I / �5-
State:....— Zip Code:
work Phone:
City:._..
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Agent Email Address:
101 (Escrow Company: ... /—z ,. �. (2i ..__.�� _._.....Escr'o/w#:__'�(y"�
Escrow Address: ,G-RY,i'�`. `.. /� City: ..4�JlU�/ ..... ��,r
State: (/ (./ Zip Code: _.... Escrow Phone: W7�-/7..`!J
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. l understand that if Building or Zoning
violations are discovered l will be responsible to correct said violations:
Owner/Agent's signature to authorize inspection: Date:
OR
Owner/Agent's signature to decline inspectio�ls..,�t Z Date: Y��
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Account # 01050504-5210, 0 ...z...........Make checks payable to: CITY OF NEWPORT BEACH
Bui1ding_0iyision\Forms\RBR_918-18