HomeMy WebLinkAboutR2022-0066 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
f(� q �1 _40 f n 100 Civic Center Drive I P.O. Box 17681 Newport Beach,
RBR# 6 G lX �/ www.newportbeachca.gov 1 (949) 644-3200
CA 92658-8915
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 Drint and complete all information
i#of Units: F: Address: /' q /'fr)C) i / City; Newport Beach State: CA Zip: 722,5-7
Property Owner:] ,. r�✓� a")F' . { ? s 4l /7 j `f_ %r
Owner Address: f�F� /!—y.D' �J0/C��G-t/f.>
State: CA it tC~. Zip Code: j�"J
Zip Code: 77/� 5
City: ��t�^ s
Home Phone:
Owner's Authorized Agent:/i�: Work Phone: PH
,77 i
Agent Address: J� {n J rlflh-rn City: / lv4
State: F Zip Code: Agent Email Address:
Escrow Company: ('A j Escrow M 5D36-
3
Escrow Address:`Ti 7
io' City:
State: Zip Code:// Escrow Phone: f
Email Report to:
For Inspection call (Name): I 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 to decline inspection:
Date:
Date:
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6.1Iding_DWW.a \Forms\NBP 7-131