HomeMy WebLinkAboutR2021-0782 - Permit ApplicationOPniJl�7}da' '
City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT kv
BUILDING DIVISION
/n�/ 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915 `'"
www.newportbeachca.sov 1 (949) 644-3200 > x
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Application for Report of Residential Building Records
Please type or print and complete all information
# of Units M Address S MNs. City:
Property Owner:
OwnerAddress:
State: ):;~i`'sr Zip Code:
Home Phone:
City:
Sate M Zip 9266d '.'
Owner's Authorized Agent: tlota ... �,..__:...s z 4 . ;._ n )Work Phone:
Agent Address d50 New ci:. pa
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State: � Zip Code:
Escrow Company:
Agent Email Address:
Zip Code:
Escrow #:
Escrow Address ;4$ thew c�r1 GEt4t Iaiot ve��ttite>6 ]n . " r e ty ` P !.c
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State � Zip Code:
Email Report to:
Escrow Phone: (f —1.11111--fl'.01
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For Inspection call (Name)._ „� t__§ r ,� rs : Direct Phone. :._ r� „ ,m,.,r;°.,.,.
CONSENT TO INSPECT (FORM MUST BE SIGNED AND DATED BELOW
Account # 01050504-521040............
checks payable to CITY OF NEWPORT BEACH