HomeMy WebLinkAboutR2021-0755 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
114100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
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: 30 A I„cA,,,l, [t, ,,, —_ _ city: Newport Beach State: ICA :Zip: a6�pa
Property Owner: �Za�r �� �Il ZZc, Zip Code:
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Owner Address: �c%f lfiflr �� City:
State: ��,, Zip Code: a02 I Home Phone:
Owner's Authorized Agent: I Work Phone:
Agent Address: City:
State: E' Zip Code: E77 Agent Email Address:
Escrow Company: .CY- �/ Escrow #: �$
Escrow Address: i�Od ri-.,�- City: pIQ G
State: [ _ Zip Code:
Email Report to: `�j�j'�
For Inspection call (Name): Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
Account ti U1U505U4-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
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