HomeMy WebLinkAboutR2021-0434 - Permit Applicationx P City of Newport Beach ; }
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COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
1 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92 915
RBR#M "y@g' b `t
,(�f www.newportbeachea.gov 1 (949) 644-3200 12 i
for Report of Residential Building Recoe&y"
Application Fee: - $194.00 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
H of Units. �� Address: �Q� �,.... (�,� 1 I ! City: Newport.. Beach,,. State: CA ',.Zip: 9
Property Owner. �� � � I — Zip Code: ZU3
Owner Address: 82 City:
State:CA Zip Code: q M3 Home Phone: r
Escrow Company: (il✓_'_` (Wq Escrow N: +r1 p.V 0Cja.- 1 6 P'...
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Escrow Address: L�(tp� �� �� City:
�a GLt
State: Zip Code: ��-'l0 Escrow Phone:
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) will be responsible to correct said violations.
Owner/Agent's signature to authorize inspection: Date:
OR
Owner/Agents signature to decline inspection: Date: ) oI 2'
Accoum: s U1uDUDU4-0G1u4u .................MOKe Cne[KS pay[lble to: CII r OF NE WPOKI BEACH
Building OiVWun\Forms\RBR J-3040