HomeMy WebLinkAboutR2022-0387 - Permits,AOEtVEO gI,
COMMUNrTY
City of Newport Beach DEVELOPMENT
COMMUNITY DEVELOPMENT DEPARTMENT JUL 5 PO2Z
BUILDING DIVISION
�J 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
RBR#� [(ice 1 www.newportbeachca.gov 1 (949) 644-3200 CITY OF
Application for Report of Residential Building Records "'�WpORT sEPG�
Please type or print and complete all information
#of Units:L( 1 Address: 1 el/'�/yx•�n City: Newport_Beach,. State: CA Zip: (�jS
Property
Owner Ac
State: CA Zip Code:
Owner's Authorized Agent:
Agent Address:
Zip Code:✓`
City: wh��
Home Phone:
Work Phone:
City:
State: I Zip Code: F-771 Agent Email Address:
Escrow Company: '�Y,'O,f (- U.l�ip %1x �`i !) %I Escrow # �� j✓� In..V �.(i..... �� il4.r _....
EscrowAddress: J+,i �: ' °�' --'-+
�\ v �l(,� i�(in[C�! l6(7 city: �I € ;(��,qlt%Il,�t```.
State: �, - : Zip Code: + 1 /7e �P-( Escrow Phone: d^( ��-_..- I --�i'� _- 0� '
Email Report to: Wd1/e ftee!JOV(ICSG+ bL-0 (OVA
For Inspection call (Name): Direct Phone: �—
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
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Account # 01050504-521040 ........... 41.Make checks oavable to: CITY OF NEWPORT BEACH
Building_Division\Forms\NBR &15-22