HomeMy WebLinkAboutR2021-0173 - Permit Applicationk"MUNITY
`'-OPNIEN)
City of Newport Beach 4' 9 5 202a
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION 7k
100 Civic Center DriVe I P.O. Bax 175B 1 Newport Beach, CA 9255$-8915
(I r\ry v
� I l 2 "w.newportbeacirca.sov ( (949) 644-3200
RtiR# lNL :J 0010�
Application for Report cif Residential Building Records
Please type or, Print and complete all Information
Property fawner: ;�steyen 1� ;tJfzlspri`and n A's� M1lelsorl ... .:.�` ' Zip Code
Owner Address s,. A i _.. .. -s _;,_- ... r,t„ H
state� Zip Code: ,4 , ._ Hone Phone
Owner's Authorized Agent ocha tiarat ..., a w.: - -_ Work Phone
Agent Address: b20Nsw'QtCenfsC:Rt5Te6S0 .:._.._ Clty
state:'
Agent Email Address:
soroiNCohlpeny
reItel sdbT�r.Bel(' e1rtjlee_.. '.„... ` ,_.._T,
EscrowMdress
B-6 1, l t0t!!e ulteD4 F w k
State, 0
Zip Code ``9' 80,?...... ` , a`
Escrow Phone:
>Email Report to
For Inspection call (Name):
CONSENT TO INSPECT (FORM MUST BE 516NED AND DATED BELOW
Account # 01050504.521040 ..........Make checks payable to CITY OFNEWPORTBEACH'