HomeMy WebLinkAboutR2023-0188 - PermitsCity of Newport Beach RECEIVED BY
COMMUNITY DEVELOPMENT DEPARTMENT COMMUNITY
DEVELOPMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA92658-'WAP 0 8 20D
R B R # (?—?-V7- 01 $ g www.newportbeachca.gov (949) 644-3200
CITY OF
Application for Report of Residential Building RecordsCITYPORT
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: Fk7Address: city:Newport Beach State: CA Zi c
Property Owner: u� Zip Code:
Owner Address: F l ` City: M
��
State: CA Zip Code: '11GV1 Home Phone:
Owner's Authorized Agent: 77 Work Phone:
Agent Address: City:
State: Zip Code: F777 Agent Email Address:
Escrow Company: Escrow #: 6 575 Z-,,,J
Escrow Address: /(� �(��(/ l City: `
State: Zip Code: `?� Escrow Phone:
Email Report to:
For Inspection call (Name):
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: F
P
O
Owner/Agent's signature to declin Date: I
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
Building_Division\Forms\R BR_6-15-22