HomeMy WebLinkAboutR2024-0106 - Permit ApplicationRECEIVED
BY
City of Newport Beach DEVELOPMENT
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION APR 10 2024
/I 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
RBR# Q/ (l2� 01 0(:1 www.newportbeachda.gov 1 (949) 644-3200 CITY OF
NEWPORT BEACH
Application for Report of Residential Building Records
Please type or print and complete all information
# of Units: I ( Address: I I ��� City: Newport Beach State: EZip: � b L
Property Owner: (/'�(�� G Uvl WV\ CW V-Amk _ \( KOA Zip Code: Fq-4
Owner Address:In A" A `u tA$, City: ?� Vj-
State: CA Zip Code: - T /, Home Phone:
Owner's Authorized Agent:
Agent Address:
Work Phone:
city:
State: Zip Code: Agent Email Address:
Escrow Company: dye U/p W Escrow #:
Escrow Address: 'LQO (iVy UV� Y- City: it fjv* -
State: Zip Code: "I!/ W 0 Escrow Phone:
Email Report to: �� •v /�clvv cX(1vq-uvvx— p (U1(dU�ivtivh
For Inspection call (Name): Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
Account # 01050504-521040 .................Make checks aavable to: CITYOF NEWPORT BEACH
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