HomeMy WebLinkAboutR2022-0152 - Permit Application�EvIVEO eY
COMMUNITY
City of Newport Beach L*V6LOPMENT
COMMUNITY DEVELOPMENT DEPARTMENT MAR 9, ZQ
BUILDING DIVISION 44
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
RBR# _ 152 www.newportbeachca.gov 1 (949) 644-3200 UITYOF
Application for Report of Residential Building Recor roar Boa,
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: n Address. �-S0mv(� ` 70 �� City: Newport Beach State: FZip: i'
Owner Address:
State:
h� Zip Code: RW111
^-_''
city: 1�r_w--- ---- - - - --�
Zip Code: R�7k& i
Home Phone:
Owner's Authorized Agent: Work Phone:
Agent Address: City:
State: 7- Zip Code: F77�� Agent Email Address:
Escrow Company: Escrow #:
Escrow Address: City:
State: Zip Code Escrow Phone:
Email Report to:
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 I will be responsible to correct said violations.
INSPECTION
Owner/Agent's signature to authorize inspection: DECLINED Dater
Owner/Agents signature odeclinei.spection: OR Date: 'j _1 (/aa,
i
Account # 01050504-521040 ................. ak the s payable to: CITY OF NEWPORT BEACH
8u1ld1n�D1v1s1on\Forms\RBR_7-1-21