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
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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
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