HomeMy WebLinkAboutR2022-0171 - Permit ApplicationCity of Newport Beach COMMUNITY
COMMUNITY DEVELOPMENT DEPARTMENT DEVELOPMENT
BUILDING DIVISION MAR 31 2027
y 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
RBR# �Z D I I I www.newportbeachca.gov 1 (949) 644-3200 Crry Or
Application for Report of Residential Building
Please type or print and complete all information
#of Units: n Address: �L� Oh�� City: Newport Beach. State: CA Zip: 260
Property
Owner Address:
State: CA Zip Code: 42O
Zip Code: FiRWO
City: N W—A t 6gaatA
Home Phone:
Owner's Authorized Agent: Work Phone:
Agent Address: I j City:
State: Zip Code: Agent Email Address:
i
Escrow Company: BI Escrow
Escrow Address: City:
State: �� Zip Code: Escrow Phone:
Email Report to:
For Inspection call (Name): Direct Phone: 1.
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
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