HomeMy WebLinkAboutR2021-0675 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
VI.n �I n 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
u �1 www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
Please type or print and complete all information
#of Units: Address: yt3...E. �a-_ �aX.,�te� N. jam, ___ City: Newport Beach State: CA Zip: ga(o(o�
PropertyOwner:RQ5�\-L,
Owner Address: 913 a }ter City: k\Zwpord- 134 aA,
State: CA Zip Code: Home Phone:
Zip Code: -I�C
Owner's Authorized Agent: Work Phone:
Agent Address: ! City:
State: Zip Code: F-71Agent Email
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Escrow Company: 1-re�cim �SwotiJ Escrow #:
Escrow Address: I%�OU NJyN } �.��}v Or. #/�U City: wewpar - ge"j,
State:I CA-�; Zip Code: 9¢GGo. Escrow Phone: QyY�G 1
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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: CITYOFNEWPORT BEACH
Buildin,Division\Forms\RBR )-1-21