HomeMy WebLinkAboutR2021-0062 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT . [. :.E ,,
BUILDING DIVISION ��� w, CD
100 Civic Center Drive I P.O. Bax 1768 1 Newport Beach, CA 92658-8915
www.newportbeachca.gov 1 (949) 644-3200 0
RBR#2
Application for Report of Residential Building Records
Please type or print and complete all information
# of Units Address 33City:
Sate _CA<, Zip:
Property Owner
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Home Phone:
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Owner's Authorized Agent „lel BanU'el_o ,`„ :Gm..', _. m RM
Work Phone:
Agent Address
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Zip Code 192660 ....,; ..,;
Agent Email Address:
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State. GA _, ;Zip
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Escrow Company
Escrow #: 4t
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State. GA _, ;Zip
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Email Report to
For Inspection call (Name) 3r ' Direct Phone x
CONSENT TO INSPECT (FORM MUST BE SIGNED AND DATED BELOW
Account # 01050504-521040 .............
payable to CITY OF NEWPORT BEACH