HomeMy WebLinkAboutR2021-0232 - Permit Applicationnot F?Tn,I City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA92658-8915 it
www.newportbeachca.gov (949) 644-3200
Application for Report of Residential Building Records
application Feer- $'-1 94. 00
Ndtice.
For: All:Residential Buildings) >Applications.with insufficient fee payment
teinspection Fee 129.00 or incomplete willbe returned'
Please type or print and complete all information
of Units: Address: j City: Newport Beach State: CA Zip:
opertyOwner: r GI Zip Code:
NnerAddress: 6&ew City:I IA
P
ate: Zip Code:y S Home Phone: I - . Z - -7
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wner's Authorized Agent: f %n Work Phone:
;entAddress: i �� r' �ity:
ate: �` J Zip Code:L� Agent Email Address:
crow Company:
scrow Address:
tate: ?
mail Report to:
Escrow
Escrow Phone: pte&Alt
or Inspection call (Name): Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
I authorize inspections and m -inspections of the property.listE
violations are discovered I will be responsible to corrects aid vi
Owner/Agent's signature to authorize inspection:
Owner/Agent's signature to decline inspection:
i1d1n�01v1sion\Farms\R8R_9-18-18
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Date: J
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH