HomeMy WebLinkAboutR2020-0805 - Permit ApplicationOEMyy City of Newport Beach " ` i"'' ' <<
COMMUNITY DEVELOPMENT DEPARTMENT t Y
BUILDING DIVISION
ZO Z0 ��5 100 Civic Center Drive I P.O. Box 17681 Newport Beach, CA92658-8915 SPP 2 JQ20
RSR# www.ne ortboachca,6ov 949 644-3200
Application for Report of Residential Building Records 01TY ()I --
Please type or Print and complete all information
# of Units:
Address: ZZO j��Ce- .LAr`e -*Z-I-Z- J City: Newport Beach State: CA_��Zip:i7-11
Property Owner:[Zip
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Owner Address: % S C o C, >,Ur City: Sa w%� r E,
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State 1FA: /U M _ Zip Code: 5c -?,r01_--_1 Home Phone: '1 �O _S,S'3 0
Owner's Authorized Agent:
Agent Address:
Work Phone:
City:
State: I— Zip Code: FI, Agent Email Address:
Escrow Company. Escrow #
Escrow Address: .------- ------------------ --SII City:. -------- ---_—_ ..- ___ - .----'II
State: Zip Code: J Escrow Phone:
Email Report to: _ S. -K 4- I! )J
For Inspection call (Name): Direct Phone: '76O �'} SS -.3 OI''
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
Account # 01050504.521040 .................Make checks payable to: CITY Of NEWPORT REACH
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