HomeMy WebLinkAboutR2023-0508 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
wait �2023 ^ 0It, 0 $ www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
RECEIVED B',.
COMMUNIP
DEVELOPMEP:
JUN p 5 ?oz3
CITY OF
NEWPORT BEACt
Application Fee: - $202.00 Notice: I
(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
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#ofUnits: l f Address:
3 City: Newport Beach
State: CA Zip:
l N7f,i,i
Property Owner: Zip Code:
Owner Address:I Is �' G CO.
City: a0,49 '.....
State: CA Zip Code: q'Z(,Q Q (> Home Phone:
Owner's Authorized Agent: Work Phone:
Agent Address: City:
State: �!,, Zip Code: Agent Email Address:
Escrow Company: Q
Escrow Address: �I of-X- -e -�f/ City:
State:
Email Report to:
For Inspection cal
Escrow#: e S%% 1
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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: T
Owner/Agent'ssignatureto decline
Account # 01050504-521040 .................Make checks`Dayable to: CITY OF NEWPORT BEACH
BUiIE'Inp DM,,5 n\Forms\RBA 6-15-22