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COMMUNITY
City of Newport Beach DEVELOPMENT
COMMUNITY DEVELOPMENT DEPARTMENT JAN 0 2022
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
RBR# v "- l O O O www.newportbeachca.gov 1 (949) 644-3200 CITY OP
Application for Report of Residential Building Records ORT VP'
# of Units Address:
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City.'.New _or# Beach `? Sate M Zip. ®92657
Property Owner Zip Code:
Owner Address:
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Work Phone
City:
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Home Phone:
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Work Phone
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State � Zip Code 93660 Agent Email Address:
Escrow Company ..Came:t 5bt1w.8s: ettlepiept_eriYipeS _..._.:::._ _.....:.
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Zip Code
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Escrow Phone:
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Email Report to:
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For Inspection call (Name) 4N....) _.. s€ Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED AND DATED BELOW
Account # 01050504-521040 .................. Make checks payable to CITY OF NEWPORT BEACH