HomeMy WebLinkAboutR2021-0230 - Permit ApplicationlJd�Q 1_aa,�,yl��
City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT j
BUILDING DIVISION yr/�
100 Civic Center Drive I P.O. box 1768 1 Newport': Beach, CA 92658.8915
n.aa
2 o q � o www.newoortbeachca,eov (949) 644-3200RBR# nv vuwa4
Application for Report of Residential Building Records
Please type or D&A andcomplete all information.
# of Units
Address5i:::aagt41'6theeti;
City ':Nein rrii Beacfl ` .:
Sate
CA? Zip.28i
... ;
Property Owner
Zip Code
2a3T..6Ih;Street, t LO "
Owner Address
:. k Cdy
..�_.. .... .. ... .._P._�.n. .i..< .�.�..... ,tt.
�
State Zili Code
Home Phone: +
Owner's Authorized Agent ,Can itt . LeaIle=F ,!-'LI :: , .m w; .. m ?.,:' 'Work Phone:
Agent Address ,214,0 ' Cante:Oz�ve. #ifl0e ._ .. m.. City: ;Newport:8each
State Oq'„ ; Zip Code 9 i0_..., Agent Email Address:
CONSENT TO INSPECT (FORM MUST BE SIGNED AND DATED BELOW'
Account #! 01050504-521040 .. Make checks payoble:to OTY'OF NEWPORTBEACH