HomeMy WebLinkAboutR2021-0777 - Permit Applicationnt,Form,: City of Newport Beach ,.
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 NewportBeach, CA926\5ii'6151
www.newportbeachca.gov (949) 644-3200
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Application for Report of Residential Building Records
Application Fee: = $198.00 - Notice: - -
(For All Residential -Buildings) Applications with insufficient fee payment
Reinspection Fee .$131.00 or incomplete will be returned
Please type or print and complete all information
#ofUnits: C Address: _ 6 City: Newport Beach State: CA JZip:
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Owner Address: G
State: CA I Zip Coder
Zip Code:
City:
Home Phone: —
Owner's Authorized Agent: ( (� Work Phone:
AgentAddress:LV&V L �l �c5� City:
---------.._.__--------
State: Zip Code:
Agent Email Address:
For Inspection call (Name):
Zip Code:I '4�
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 l will be responsible to correct said violations,
Owner/Agentssignaturetoauthorize inspection: Date:
OR
Owner/Agent's signatureto decline inspect Date:
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Building Division\Forms\RBR 7-1-21