HomeMy WebLinkAboutR2020-0812 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
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r�� nn y 100 Civic Center Drive P.O. Box 1768 1 Newport Beach, I
RBR# F��V—00— www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building
Please type or print and complete all information
#of Units: I ' i Address: 109 33rd Street City: Newport Beach State: CA zip: 82663
Property Owner: fames Stearman Zip Code:
F 77
Owner Address: F City:
State: CA �'I Zip Code: �' Home Phone:
----------------
Owner's Authorized Agent: �- 7 Work Phone:
Agent Address: City:
State: Zip Code: Agent Email Address: _..... _ .._ ..._._ _..
Escrow Company: Freedom Escrow Escrow#: 054037 -MM
Escrow Address: 11200 Newport Center Dc, Suite 180 _1 City:Newport Beach
State: Cq Zip Code: 92663 Escrow Phone: (949) 644-3939
Email Report to: mm@freedOmeSCrow.Com '.....
For Inspection call (Name):
I authorize inspection
violations are discover
N/A Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
vwner/Agent s signature to auunonze inspection:
ierty listed above.) unders
!ctsaid`violations'.'
Owner/Agent's signature to decline inspection: AN w f '.�;
BuildinggDivision\Forms\RBfl 7-30-30
Account # 01050504-521040 .................Make checks payable to:
OF NEWPORT BEACH