HomeMy WebLinkAboutR2022-0147 - Permit Applicationam City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
RBR# lwww.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Buildine Records
`Aoolication Fee: -$198.00
Notice:
EFor All Residential Buildings)
Applications with'insufficient fee payment
Reinspection Fee $132.00 - or incomplete will be returned
Please type or print and complete all information
#of Units: FF Address: V�l CJ'ul +� ''
City: Newport Beach State: CA Zip: i -E
PropertyOwner: ~75 "•+' A a.naT
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Zip Code:
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State: CA Zip Code: I__J__"4_W_✓_I
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Owner's Authorized Agent:
Work Phone: ®✓SZ3ai! • C� vu
Agent Address:�Ptl'J/1�.
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City:
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State: �� Zip Code: IG i u
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Escrow Company: p,o�o,iVt v'cS vN��....... _.
Escrow#:
Escrow Address:
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City:
State:I
CA Zip Code:
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Escrow Phone:
Email Report to:
For Inspection call (Name):
Direct Phone: 1.
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 twill be responsible to correct said violations.
INSPECTION
Owner/Agent's signature to authorize inspection: Date:—
Owner/Agent's signature to decline inspection`
Date: 3
Account # 01050504-521040 ake rharkc nmmhla rn r'iry nc ucurnnnr ncnru
Buildmg D10M.n\Forms\RBR 11-11