HomeMy WebLinkAboutR2021-0401 - Permit ApplicationCity of Newport Beach 'V[7L0PT,41 rr
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COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION MAY 2'X 2023
UPI-
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
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V 2P I_ oq 0 1 www.newportbeachca.gov 1 (949) 644-3200 ciTv c p
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Application for Report of Residential Building Records'
Please type or print and complete all information
# of Units: M
Address 2Q4A ate Avenu, e „.. ..,.;, City =lexyport_Beac„h, , „); Sate
CA,, Zip
Property Owner
Zip Code
141Y' LITTLE;P6STAGEis MP,LL 1 i.....
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Owner Address:
City:
State
Zip Code r :..._...:. Home Phone: , , . 3 ., .fi= `
Owner's Authorized Agent:
Agent Address:
State CA' ...: Zip Code P9'662 . m's
Escrow Company Granit€
Escrow Address 450;'Ne4
State CA ,:?: Zip Code:
Email Report to t''tlffon
For Inspection call (Name):
Work Phone:
City:
Agent Email Address:
Escrow #:
City:
Escrow Phone:
Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED AND DATED BELOW
Account # 01050504-521040 .................. Make checks payable to CITY OF NEWPORT BEACH