HomeMy WebLinkAboutR2021-0574 - 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# iC V L V "� www.newportbeachca.gov 1 (949) 644-3200
ication for Report of Residential Building Records
Please type or print and complete all information
# of Units: Address: by- Cit New ort Beach State: CA Ziali
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Property Owner. ICYtS�-.�.. L- QovtnQ,v-,q _-_-__--_ Zip Code:5a-as
Owner Address: la1S OU\rl Q✓ QY• City:
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State: CA Zip Code: gi6yS Home Phone:
Owner's Authorized Agent: Work Phone:
Agent Address: City:
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State: Zip Code: F777 Agent Email Address:
Escrow Company: FrQp jm Gat,voW Escrow # 1_0& Ll
Escrow Address: l" r, 'lE ISO City:
State: 5A Zip Code: 9?66b Escrow Phone: 4 Ori
Email Report to: SvJ Cote,
For Inspection call (Name): Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
Account # 01050504-521040 .................Make checks payable to: CITY OFNEWPORTBEACH
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