HomeMy WebLinkAboutR2020-0823 - Permit ApplicationRBR# UN -0 2 3
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City of Newport Beach
COMMUNITY, DEVELOPMENT DEPARTMENT SEP 22 RECD
BUILDING, DIVISION"
100 Civic Center Drive (R0. Bax 1768'1 Newport Beach, CA 92658-89SSDEVEIOPMENT UZ
WwW.newoortbeachca.edv i (949) 644-3200 Q FP
Application for Report of Residential Building Records OP NEWFOP"�
Please'tvae or print and complete all Information
# of Units: M Address:.I7.. Ll st (5ceanirpnt , : City: ,Newpotl, l3eact,, ,; Sate: GA + Zip: .9 6Tx i
Property Owner:
Owner Address:
State: F77
Home Phones
Zip Code,
Owner's, Authorized. Agent.
Work Phone
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Agent Address:
City:
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'NaBach
State: YxA `':
Zip Code:
n'92 6 . ` ;_
Agent Email Address:
Escrow Company:
Escrow#: 104.43334 -JAM.. '
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Escrow Address:
City:
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State*
Zip Code:
'2660 �` t -
Escrow Phone:
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Email Report to:
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For Inspection call
(Name).
Direct Phone:
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CONSENTTO'INSFECT (FORM MUST BE SIGNED AND DATED BELOW'
Account # 01050504-521040 .............Make checks payable to CITY OF NEWPORT BEACH