HomeMy WebLinkAboutR2021-0733 - Permit Applicationco[u�tsunu.f_._.
City of Newport Beach o,tve'-" "10 NT
COMMUNITY DEVELOPMENT DEPARTMENT 1071
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 ( Newport Beach, CA 92658-8915
Ib u www.newportbeachca.gov 1 (949) 644-3200 T`%i'
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Application for Report of Residential Building Records
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# of Units: M Address
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Pro ert Owner. „� Y ` T,", ,o� Zip Code:
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Owner Address rw :- ��.k ' , � 3,' , iCity:
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State:7,� � "� Zip Code .�' :`- , �s.�tJ,i6":.._.w. s(
Owners Authorized Agent „ , . ,. ,.i.; _._.. Work Phone:
Agent Address 14.45D City:
State CA."' Zip Code J660 ,' s. Agent Email Address:
Escrow Company m 'ranite:E"scsbw Escrow #: C14,45 (' TLCr
Escrow Address: 450 Witor)E;eht6P,GS1ia'=Ultd 60 ;,. r City:
State: A', Zip Code 82&60
Escrow Phone:
Email Report to: f'riffnft tdniteescrdw:carrs:i
For Inspection call (Name) e Direct Phone: f `
CONSENT TO INSPECT (FORM MUST BE SIGNED AND DATED BELOW
Account # 01050504-5?1040..................Make checks payable to CITY OF NEWPORT BEACH