HomeMy WebLinkAboutR2022-0057 - Permit ApplicationRBR# flo n -�O—�
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COMMUNITY
City of Newport Beach DEVELOPMENT
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION FEB 0 3 1022
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
www.newportbeachca.Pov 1 (949) 644-3200 CITY OF
Application for Report of Residential Building Recor.A k. ORT e�PG
Please type or print and complete all information
# of Units: M Address East`d ewater=`Pla`c City:
Property Owner:
Sate Zip
Zip Code:
Owner Address
-0104
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State:
Zip Code
Home Phone:
n ; m____., '. •.u3
Owner's Authorized Agent: Work Phone:
Agent Address. 341#3a si a Onve .-.......: City. ,:NeW arE.Be3chn...
State � Zip Code :3266U - E : Agent Email Address:
Escrow Company:
Escrow #:
Escrow Address
50_New' o}t Cenfer„„)npe, Suue fi00 s.Y _, City New Qrt?$each a : , _...............
State: � Zip Code '=52560 ...,;.. .__..:I Escrow Phone. 72D-01 [Q
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Email Report to: _:.
For Inspection call (Name) „ ,, „ Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED AND DATED BELOW
Account # 01050504-521040 .................. Make checks payable to CITY OF NEWPORT BEACH
Building _DMsion%Fmms\RBR_)-1-21