HomeMy WebLinkAboutR2021-0395 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
��� 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
RBR# @,� www.newportboachca.gov 1 (949) 644-3200
ication for Report
Residential Building Records
Please type or print and complete all information
# of Units: "� J Address: ���: �V_V City: Newport Beach State: CA Zip:5 —
PropertyOwner. (-� �, ,���> —_ _� Zip Code:
Owner Address: City:
State: CA Zip Code: Home Phone: —
Owner's Authorized Agent: J V,j r;��I Work Phone:
Agent Address: j� City:
State: Zip Code: Agent Email Address:
Escrow Company:�Y --� Escrow #:``^��
Escrow Address: l �� �7�1 i��41s ty: l'
State:Zip Code: tom+ Escrow Phone:���'
Email Reportto:'—�IN�-1�xl�d�l�.,_ I
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For Inspection call (Name): _ l Pi _ Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
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