HomeMy WebLinkAboutR2022-0327 - PermitsPrint Form City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
RBR# Z www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Buildine Records
Application Fee: - $198.00 Notice:
(For AIIResidential Buildings) Applications with insufficient fee payment
Reinspection Fees 131.00 or incomplete will be returned
# of Units: I 7 Address: r
PropertyOwner:l W&
Owner Address: �S!
State:_-
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Zip Code:R
City: Newport Beach State: CA 'Zip:
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Home Phone: Cr 1 r
Owner's Authorized Agent: Work Phone
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Agent Address: -34d (l ` (4N JL N_ City: 1
Agent Email Address: ,
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Escrow Company: C Escrow #:
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Escrow Address: � Pj` ,-i -,�i City: (�'jo-ti Vic, hel -PjcCZCV�
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For Inspection call (Name): Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED a 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 responsibleto correct said violations.
Owner/Agent's signature to authorize inspection: INSPECTION„«e.
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OR
Owner/Agent's signature to decline inspection:�Ul �1A Date:
Account PUlU5USU4-521040.................Make checks payable to: CITY OFNEWPORTBEACH
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