HomeMy WebLinkAboutR2023-0635 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
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RECEIVED BY
COMMUNITY
DEVELOPMENT
Jul 18
BUILDING DIVISION (u4j
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
RBR# �2023 - O (0 35 www.newportbeachca.gov 1 (949) 644-3200 CITY OF
NEWPORT BEACH
Application for Report of Residential Building Records
Application Fee: - $202.00 Notice:
(For AIIResidential 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: �/ City: Newport Beach State: CA Zip:
PropertyOwne r. ' -V ('�(,�' Zip Code:
Owner Address: oN City:
State: CA Zip Code: FWZ
Home Phone:
Owner's Authorized Agent: Work Phone:
Agent Address: City:
State: F7--71 Zip Code: E777 Agent Email Address:
Escrow Company:4KZ"j
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Escrow Address: Z&`�BiXN75T7� _� city: I A 1
State:T77--7 Zip Code: 9 �&lX
Email Report to:
Escrow #: 6
For Inspection call (Name): Direct Phone: 1-1
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: I r
O
/u I
Owner/Agent's signature to decline Date: . V 2 Z
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Building Division\Forms\RBR_6-15-22