HomeMy WebLinkAboutR2021-0308 - Permit ApplicationDocuSign Envelope to: 6F2080A5-A21943DA-82D1-07C32C8D3060
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' City of Newport Beach 'AVE),)a„\�, ,
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COMMUNITY DEVELOPMENT DEPARTMENT Vitt tF,i,4Gh6 Y
q f/ BUILDING DIVISIONft o [J- 0 J 6 b 100 Civic Center Drive I P.O. Box 1768 j Newport Beach, CAA?6,58-$93($21
RBR# www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Recofilsr
Notice:
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or incomplete will be returned
Please type or Print and complete all information
#of Units: Address: 9SeabiUff City: Newport Beach State: Zip: 92660
ProperkyOwner. Donte Andrjl Zip Code:
owner Address: City:
State: F7777 Zip Code: Home Phone:
Owner's Authorized Agent: I Maryam Samini
Agent Address: 4 Corp. Plaza Drive #100
Work Phone: 949.422.3688
City: Newport B e a c g h
State: I CA Zip Code: 92660 Agent Email Address:
Escrow Company: Escrow Options Group Escrow #: I 5 -7030 -SA
Escrow Address: 1 2124 Main Street # 250 City: Huntington Beach
State: CA Zip Code: 92648 Escrow Phone: F714.274.2710
Email Report to: TeamShastin�a Escrowgptions.cpm
For Inspection call (Name): I Maryarri Samini Direct Phone: 949.422.3688
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
Account # 01050504-521040 .................Make checks payable for OTY OF NEWPORTBEACH
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