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HomeMy WebLinkAboutR2022-0075 - Permit Application�,eCEIVEO wy I 17COMMUNITY Pri7t,Form^ City of Newport Beach DEVEf.OPMENT COMMUNITY DEVELOPMENT DEPARTMENT FEB 1 BUILDING DIVISION 6 2022 Ivic Center Drive I P.O. Box 1768 i Newport Beach, CA92658-8915 RBR# W�O v 0 www.newportbeachca.gov 1 (949) 644-3200 CITY OF A— Application for Report of Residential Building RecorORT sept` 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: 1 A/ a �!y% City: rNew ort Beach State: CA Zip: I/ �.� I t I Newport p el�iC7 - Escrow Company: Escrow #:1 -1176 Escrow Address: Ail&)O..;q?'lxr`%f`..O ..,. OCity: State: C A Zip Code: - - Escrow Phone: r Email Report to: ,,Nales c 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 l will be responsible to correct said violations. Owner/Agent's signature to authorize inspection: Date: OR Owner/Agent's signature to decline inspection: Date: �i:/6-,!�7 t. Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH eu!Tdin�oivi:1on\E0rms\RBR7-1-21