HomeMy WebLinkAboutR2022-0070 - Permit ApplicationPrint Form
to 11-640
City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 17681 Newport Beach, CA 92658-8915
www.newportbeachca.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
# of Units: Address: 3 t�� City: Newport Beach State: CA ',Zip:�j 7
Newport
PropertyOwner: 'Zmle ii �Z' OSSL'LVCZcI e Zip Code: % Sr%,
Owner Address: I s 1 1 City: (J lA&W 1 �4c�c[ S
State: CA Zip Code:
F?) U S% CHe� Phone: 40C 66 -r%
Owner's Authorized Agent: Work Phone:
Agent Address: City:
State: f — Zip Code: F Agent Email Address:
Escrow Company: Escrow #:I
Escrow Address: City:
State: I Zip Code: 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 I will be responsible to correct said violations. f�
Owner/Agent's signature to authorize inspection: l/j /�0�------� Date:
4444 / OR
Owner/Agent's signature to decline inspection:
Bullding Division\Forms\RBR_7-1-21
Date:
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH