HomeMy WebLinkAboutR2022-0205 - Permit ApplicationCOMMUNITY
Print Form City of Newport Beach ot-wELOPMEN1
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION APR 14 202Z
r 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
RBR# ����� www.newportbeachca.gov 1 (949) 644-3200 vI7Yt
Application for Report of Residential Building Records"%PORT
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
#ofUnits: � Address: Z,�'� L,�-,f,i �r( _ City: Newport Beach State: Flop:
C F `E 2
Property
Owner Address:
State: CA_
Zip Code: WSJ
Zip Code: 75trt_i-J
Owner's Authorized Agent: Work Phone:
Agent Address•.---LCXJjl�PC7V_ City: _ ----_--_-----I
State: -t--- - _i Zip Code:RAx7eqq Agent Email Address:��iLrtr
Escrow Company: ,rQ '��_,).�y i, „__�-----_ Escrow #: t/ ,t�l _l,(J._._..._____i
Escrow Address: 1 ��_t-�F�J r�tr•�.� t City:�j, - `_ ,�/' 6
I._—!Gf'-C__t�1_6ZQ�r:'i''I _�Ili� -. _------- -elf Y y�
State:FOAL Zip Code: �' Escrow Phone: �' r^
Email Report to:
For Inspection call (Name): p `� _ 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: lv �`� - _.;�
'� Dater
Owner/Agent's signature to decline inspection: Date:
Account # 01050504-521040.................Make checks payable to: CITY OF NEWPORT BEACH
BuIIdin�Division\Forms\RBR 7-1-21