HomeMy WebLinkAboutR2021-0394 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA92658-8915
RBR# 'j,U�G - www.newportbeachca.gov (949) 644-3200
n for Report of Residential
Please type or print and complete all information
# of Units: � Address: `S PM� City: Newport Beach State: CA Zip: C� Z (--
Property
Owner Address: City:
State: CA Zip Code: Home Phone:
Owner's Authorized Agent:
Agent Address: City:
State: Zip Code: �� Agent Email Address:
Work Phone:
Zip Code:
Escrow Company: �C(' V�� _ Escrow #:
Escrow Address: '' ,ALI `
State: 1 C4 Zip Code: flauD Escrow Phone: ICILY] —ULAL 1
Email Report to:
For Inspection call (Name): Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
Account # 01050504-521040 .................Make checks payable to: CITY OFNEWPORTBEACH
Building 0lvlslon\Forms\RBR]-30-20