HomeMy WebLinkAboutR2023-0123 - PermitsRECEIVED BY
City of Newport Beach COMMUNITY
COMMUNITY DEVELOPMENT DEPARTMENT DEVELOPMENT
BUILDING DIVISION FEB 17 2023
100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA92658-8915
R B R # - 22023 r p 1 23 www.newpor-tbeachca.gov (949) 644-3200 CITY OF
NEWPORT BEACH
Application for Report of Residential Building Records
Application Fee: - $202.00 Notice:
(For All Residential Buildings) Applications with insufficient fee payment
Reinspection Fee $134.00 or incomplete will be returned
Please type or print and complete all information
# of Units: Address: �� , / n City: Newport Beach State: CA Zip:
tb
Property Owner: Zip Code:
Owner Address: 2A 9 Co ej&w City: (Aa
State: CA Zip Code: (Q Home Phone:
Owner's Authorized Agent: Work Phone:
Agent Address: City:
State: Zip Code: Agent Email Address:
Escrow Company: Escrow #: G 5'5�`70
Escrow Address: l`�� V► 1 VV 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.
Owner/Agent's signature to authorize inspection: Date:
Owner/Agent's signature to decline s' �F Date:
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Account # 01050504-521040 .................Make checks payable to: CITY OFNEWPORTBEACH
Building_Division\Forms\RB R_6-1S-22