HomeMy WebLinkAboutR2021-0243 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 17681 Newport Beach, CA92658-8915
www.newportbeachca.gov 1 (949) 544-3200
Application for Report of Residential Building Records
Aoohcation .
Fee.Natfice
194.DO 0,
[06r?�Lil'Rbiidontial Buildings) A iolicitldns'�;ith:'lr�-Uffic I !an . t payment]
or Incotripletti.will -be returned'
24100
Reinspection Fee �1'
Please type or print and complete all information
of Units: El Address: City; Newport Beach, State: Zip:
ropertyOwner: LA(VCy_ Umnc _Tru_zs� Z Code: ZIPS
)wner Address: J city:
tate, FCA � Zip Code: I Home Phone:
L 7E)wner's Authorized Agent: Work Phone&S (--FE-
kgent Address: iq L 0 City: r, 06 yy\\F_1
tate: Zip Code: ii iy Agent Email Address: ccs' -3- '2�`t'P I C_L�A �6z�r�
scrow Company:
is -crow Address. I ILA'cz)
sate: Zip
Email Rep,rtto; :5r�
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For inspection call (Name):
ownir/Agent's signature to authorize Inspection:
Escrow #:1
City:
Escrow Phone: ORl_.- 0 gy otvott
Direct Phone:
ORM MUST PE SIGN91) & DA= 5ELOW1
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that if HUI dingor
Date:
OR.
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Date:
-11 ,5)6L
Account # 010 .... Make checks payable to: CITY OF NEWPORT BEACH
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