HomeMy WebLinkAboutR2021-0228 - Permit ApplicationCityof Newport Beach'
CDMMuNITY DEVELOPMENT DEPARTMENT ?ZnZ '9 2jv0;
BUILDING DIVISION,
100 C Wt Center Drive. I P.O. Bax � 76$ Ne I
wport8eath,CA 92658-8915 e.tinanefa��i�
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�W Z'"QG 1i K www.newooRpeachca v I (949) 644.-3200
Application for Report of Residential Buildina'Rnnawdc
,Please type or print and comoiete ali' Information
# of units:
Property owner', Sfa a L, oild r, Zip Code
Owner Address ` r
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State =ZIP Code ._.;
Home Phone. r;' 0. _ r _._ MO.,,
Owners Authorized Agent::.:IGr
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Agent Address aI200 " ii Cetrtter lS veSo i} f
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State p...: Zip bode €66t„ _ .. .__•:''
Agent Email Atldress
Escrow Conpanyttairi
Escrows
EscroM1 Address:
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Email Report to
For inspection call (Name): t .a R _ Direct Phone. -,i
CONSENT TD INSPECT (FORM MUSTBE SIGNED AND DATED BELOW
Account # 01050504-511040 .........Make checks poydbJe to C17y oFMEWpORTBEACH