HomeMy WebLinkAboutR2021-0793 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
www.newportbeachca.gov 1 (949) 644-3200
RBR* wq �
Application for Report of Residential Building Records
#of Units'
i PND�! N MNIES N 1 r..' MM� M 0,
city H
_ach--- H
Address: Sate:
.. . .. ..... ........... -111my.1111
p
rM -i A
............... m-'
Wi-E& Zip-,
q-
78 . .....
Property Owner
Zip Code;
Zip Code:
Home Phone:
City =N
Owner Address ,::
ZipCodp-
City
... . .... ....
Escrow Company
State'
Zip Code:
Home Phone:
City =N
M941 i
191,11.HHHH"N
.... . ......
H. ME
g .9
1 01
Owner's Authorized Agent.
ZipCodp-
Agent Email Address: 0 T . .
Work Phone:
Escrow Company
.......... —M.
Agent Address: ,45ti New ort 11
Escrow #:
e R
City =N
StaW
ZipCodp-
Agent Email Address: 0 T . .
21 � -Lq
....... .... ........ .......
Escrow Company
Escrow #:
�60 8
, rite Esi iW,'"OlEmeiiir
M941 i
Escrow Address:
�HM 6
114.40-`N W6 fl- -11SU-4t HIM city;
... iMMMM,EM-� � M.- mm -
-.,Hj1&grfl H
rhmfg fln L
State: Zip Code:, -1,V266 i`,211-11- 12"
Escrow Phone: 1.
`-1P M -M iogj-
M 1 9. 1 j�
-7, (H TIM, MFE
=FH -1--1-1
j
H�
Email Report to: Ill.
ffl;
R.
For Inspection call (Narne)-.' 5* IBM,, I I i0061111HI"HM", NI -1 'Direct Phone: H."M ISOM 111-1.
CONSENT TO INSPECT (FORM MUST BE SIGNED AND DATED BELOW
Account # 01050504-521040--- ............Make checks poyoble to CITY OF NEWPORTBEAck