HomeMy WebLinkAboutR2022-0082 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
� 01q 0 0 � � 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
RBR# I f U www.newportbeachea.gov 1 (949) 644-3200
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: IT Address: City: Newport Beach I State: CA Zip: ice'
Property Owner.clit � - - 1U1y2l'�`O�U Zip Code:
Owner Address:
State: J Zip Code: 9, j� Home Phone: I/ 7 Og tea-? — C2 mei
Owner's Authorized Agent: �— _ J Work Phone:
Agent Address: _I City: J
State: _ Zip Code: F_ Agent Email Address:
Escrow Company: L
L` ��°) _iel _I�
Escrow Address: .��ln v�, , I�--i City:
State: I— CIA-- Zip Code: L �O 7— —I
Email Report to: I rAw- 9
For Inspection call (Name):
Escrow #:
Escrow Phone: d �7/
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 I will be responsible to correct said violations.
Owner/Agent's signature to authorize inspection:
Owner/Agent's signature odeclinei spection:
Date:
OR
� Date:
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
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