HomeMy WebLinkAboutR2021-0199 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
to
�j, 0 E � q 100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA 92658-8915
RBR# P "t 9 www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
Please type or print and complete all information
# of Units: Address: New ortBeach State: CA Zip: 2025_!City
PropertyOwne
Owner Address: 2'L 11�i5 �`� City: P
State: CA Zip Code: ii� Home Phone:
Zip Code:
Owner's Authorized Agent:/_ Work Phone:
Agent Address: City:
State.� Zip Code � 1 Agent Email Address:
Escrow Company:/Escrow #:
Escrow Address: ('�(� ��
State:! Zip Code: Escrow Phone:
Email Report to:
For Inspection call (Name): - -- Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
Buiding--Division\F.,.s\NBR_7-30-20