HomeMy WebLinkAboutR2023-0526 - Permit ApplicationRBY
City of Newport Beach COMMUOMMU NITY
DEVELOPMENT
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION JUN 07 2023
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
ROW(C 2023 — c)F,ywww.newportbeachca.gov 1 (949) 644-3200 CI(Y 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
r# of Units: Fr-1 Address: City: Newport Beach
Property
Owner Address:
State: CA
State: CA Zip:
Zip Code: IS_Grt' cp
City:
Home Phone:
Owner's Authorized Agent:—� Work Phone:
Agent Address: City:
State: � Zip Code: E Agent Email Address:
Escrow Company: Escrow It: 65 3?53 - V
Escrow Address: iftwo
City: g
Yv
State: I Zip Code: I "!/AO/'o 01 Escrow Phone: 7 �/q - 1I3
Email Report to:
For Inspection call (Name): Direct Phone: I
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:
Own er/Agent's signature to decline
Date:
Date:
Building DWisian\Forms\RHR 6-15-22
Account It 01050504-521040 .................Make checks payable to: CITY OFNEWPORTBEACH