HomeMy WebLinkAboutR2021-0164 - Permit ApplicationDocuSign Envelope ID: 4A13358F-81A3-48DE-B321-D9EC1FF7289E Ii1
i?r4nt dorm .` _ City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT�'�`d
BUILDING DIVISION ���JJJ G lid
c�w 01in�� 100 Civic Center Drive I P.O. Box 1768 ( Newport Beach, CA92658-8915'
RBR# 1Y www-newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
Application Fee:- $194.00 - Notice:
(For All Residentlal.Buildings) Applications with insufficient fee payment
Reinspection Fee $129 00 or incomplete will be returned
# of Units: Address:
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print and complete all information
fj City: Newport Beach
State: CA Zip:r
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Property
Owner Address:
State: CA
Zip Code:
City: LAL- -
Home Phone:
Owner's Authorized Agent:Alad�`� `f WorkPhone:�_�j,
Agent Address: ItV:
State: — Cg — Zip Code: ni s Agent Email Address:
Escrow Company:�pC -kr� t -t- I Escrow #:
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Escrow Address: G �-/' �i �.�ff"' `�j`/ h'y� 3 l�" City: _ �q, /'
State: ! tom.f- Zip Code: Escrow Phone: (I- "� llro&a y j
Email Reportto: ; (Q /K zrf &I i/
For Inspection call (Name): T _ — �^ { _ Direct Phone: -�
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
I authorize inspections and re' -inspections ofthe'prop(
lei stand that if Building orZoning'
Date:I ... i
Orrnnnt tt
6u11d1ng D1v1s10n\F0rms\R8fl_1-30-20
Make checks savable to: CITY OF NEWPORT BEACH