HomeMy WebLinkAboutR2020-0864 - Permit ApplicationDocuSign Envelope ID: EBCBF9E8-15984683-86D0-293489BAEFC6
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City of Newport Beach
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COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION �.�3t
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-PBAAV4V4o0
RBR# www.newportbeachmgov 1 (949) 644-3200 0
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Application for Report of Residential Building Records
Please type or print and complete all Information
# of Units: Address: 309 Carnation City: Newport State: Zip:
1 11 1- F [CA- 92625
Property Owner. Fabricant Family Trust
ZipZip Code: F6497
Owner Address: 309 Carnation
City: Corona Del mar
State:P7
Fc A Zip Code: Home Phone: 9496328663
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Owner's Authorized Agent: go�{ t Fo,6rte-mi&4 Work Phone: 4q-690- 72-3I1
Agent Address: Z 0 W7D-e-e-oLATro �vt�, city: r t G&
State:
State: Zip Code: F
Z -op 3 Agent Email Address:
For Inspection call (Name): Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORrBEACH
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