HomeMy WebLinkAboutR2022-0046 - Permit ApplicationM City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
�(1 it �I/-0 � n100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
RBR# ,(N Inc (l"� U( www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
Please type or print and complete all information
# of Units: aAddress:33-,XLq City: Newport Beach] State: CA �IZip: �-7 td,( -3
Property Owner: w p a -0c, 5' Zip Code: 17-(e ( t
Owner Address: 33 3t �-�6 s l7 t-.t_� City: (\0,� t�_Cl vhV
State: CA Zip Code: Home Phone:
Owner's Authorized Agent: Work Phone: �—
Agent Address: City:
State: Zip Code: Agent Email Address:
Escrow Company: _1F,.(�Q,AD"" , Escrow#:">j5 \,--k -
Escrow Address:aS�' I66 City: t124�aC��
State: � Zip Code:
..-q'��� Escrow Phone: cq 1 Sol3 a\
Email Report to: I yr ® X�-E' c� �/Y� .P S L. f-- a �� e ,'� !�-•
For Inspection call (Name): Jp�s O �,� Q,..� Q S Direct Phone: �{ �. -1� 3 °� 3'',..°I
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CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
Ire inspections of the property listed above I understand that if Building or Zoning
wi II be responsible to correct said violations.
wthorize inspection: Date:
OR
lecline inspection:-"'- Date:
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH