HomeMy WebLinkAboutR2022-0155 - Permit ApplicationCity of Newport Beach DOMED ey
COMMUNITY DEVELOPMENT DEPARTMENT COMMUNITY
BUILDING DIVISION
DEVQLOPMENT
n 1C�100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915 MAR 2 2 20ZZ
RBR# ✓J www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records CITY OF
Please type or print and complete all information
#of Units. Address: 5%� �Q��Q City: Newport Beach State: CA Zip: 92�p2�
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PropertyOwner:
Owner Address:
State: CA
51 2 Ovtic`
Zip Code: EqW77F11
Owner's Authorized Agent:
Agent lAddress:
I
State: 1 Zip Code: F7-71 Agent Email A
Zip Code:
City: NQ,wwow+ ✓la I fMa
Home Phone:
Work Phone:
City:
ddress:
Escrow Company: „_.� � C Escrow #: b57 2 S(
Escrow Address: Mb NQ�..�(�oryF� 4-r pi2#1� 11
State: �� Zip Code:
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Email Report to:
City:��
Escrow Phone:
For Inspection call (Name): Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
Account # 01050504-521040 .................Make
Building D'wWw\Forms\RBR_)-1-21
to: CITY OF NEWPORT BEACH