HomeMy WebLinkAboutR2021-0213 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA92658-8915
www.newportbeachca.gov (949) 644-3200
Application for Report of Residential Building Records
Please type or print and complete all information
# of Units: I ' Address: 1 Q C8V81110f1
City: Newport Beach''
State: CA Zip: 92657
Property Owner: BarbaraA. Danzi
':
Zip Code:
Owner Address:
-.-.-I City:
State: CA Zip Code:
Home Phone:
Owner's Authorized Agent:
Work Phone:
----------------
Agent Address
City:
State: Zip Code:
Agent Email Address:
.....
Escrow Company: LFreedorn Escrow
Escrow #: 054497 -MM
Escrow Address:
1200 Newport Center Dr., Suite 180
City:
Newport Beach
State: CA Zip Code:92660
Escrow Phone:
(949) 644-3939
Email Report to:
mm@freedOmeSCfOw.COm
For Inspection call (Name):
N/A
Direct
Phone:
j
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
I authorize inspections and re -inspections ofthe property listed above. I understand that if Building or Zoning
violations are discovered l will be responsible to correct said violations.
Owner/Agent's signature to authorize inspection: Date:
OR
Owner/Agent's signature to decline inspection: Date: ;
Account It 01050504-521040 .................Make checks payable to: CITY OFNEWPORTBEACH
Bu Iding_DM.ion\Forms\R3R_7-30-20