HomeMy WebLinkAboutR2021-0583 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT COI\Fd'AUNl1y
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BUILDING DIVISION
V q d �0 0� 70 � 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92 � $1§ 202,
RBR# -C UC/ www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Buildine Record i1Y01-
Please type or print and complete all information
#of Units. Address:
_1 Greens Bluff T m City: Newport Beach, State: CA jZip: 926571 __._ mm
Pro ert Owner: Steve Dickler Q
P Y _... Zip Code: I /'„
PO Box 1048 Corona Del Mar ll
25
Owner Address: City:
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State: CA Zip Code: 92,625 Home Phone:
Owner's Authorized Agent: ( Work Phone:
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AgentAddress:
_�ss: �'J ►'—I—___---- ! City: N C,n
State: I - O ( Zip Code: n�
FN_)_ l ,t _ - Agent Email Address: N
Escrow Company: r%m.�..n J-t--..__'ts.�`(_.[.�q�.--..___ Escrow #
Escrow Address: 1 V.... I y..�-J.I� I Qty: N G.....Ch ....... _... ....... '�
State: /'(7 Zi Code: j�—(�—�' (—_ / C "C� n'f�/� ---
_i 5�.,Q p ._I '-f-(L_5.Q , C-�� i^ Escrow Phone: G 3,0—Q413
Email Report to:
For Inspection call (Name): I N
8ulIdine Division\Farms\RBR 9-18-18
Direct Phone: � I
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH