HomeMy WebLinkAboutR2021-0754 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
�' �� 100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA92658-8915
RBR# www.newportbeachca.gov (949) 644-3200
Application for Report of Residential Buildinv Rprnrrlc
Please type or Print and Complete all information
# of Units:
Property
Owner Address: {�I Ca0c, -*76a
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State: CA ! Zip Code: FAf_/�,"�
City: Newport Beach State: CA Zip: q_ ley —`k
Zip Code:
City: Nam, (217-1- Y3'a-- f -
Home Phone: `��"'l
Owner's Authorized Agent: ( Work Phone:
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Agent Address: City: -
State: F—Zip Code: C771 Agent Email Address:
Escrow Company: �jreGJ6i,��SCro� Escrow#:C�rL
Escrow Address: �200 �Q W�-q .C, �..•��" City:
State: _ Zip Code /�nl
_._.__.._ . 7WA6.o. -- Escrow Phone:
Email Report to: e,/�—
For Inspection call (Name): —�,
Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
Owner/Agent's signature to authorize'inspection;
Account # 01050504-521040 .................Make checks payable to:
Bui1dlnB DMsion\Forms\RBR 7-1-21
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