HomeMy WebLinkAboutR2021-0198 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
0 0 Civic Center Drive I P.O. Box 1768 Newport Beach, CA92658-8915
RBR# V20Z www.newportbeachca.gov (949) 644-3200
Application for Report of Residential Building Records
Please type or print and complete all information
# of Units: Address: city: Newport Beach J State: CA Zip:
Property Owner: Zip Code:
Owner Address: )AA&WN----7 City:
State: FCA: Zip Code: Home Phone:
Owner's Authorized Agent: Work Phone: 1041
Agent Address: City:
----------7 7
State: F Zip Code: [
Agent Email Address:
Escrow Company: Escrow #: Lff
Escrow Address: —ACM City:
State: FP 11— Zip Code: Escrow Phone:
I L,4. -V LqL-f/J-U44
Email Report to: f el -471)
For Inspection call (Name): L Direct Phone:
I
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
Building Division\Forms\RBR 7-30-20