HomeMy WebLinkAboutR2020-0877 - Permit Applicationc�UMUUNITY
amCity of Newport Beach f)r--VF.i nne
COMMUNITY DEVELOPMENT DEPARTMENT ZVI)
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8,911.5oc
RBR# ��/� ' C%V�% www.newportbeachca.gov 1 (949) 644-3200•
Application for Report of Residential Building Records
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#of Units:1❑ Address: 12640th Street City: Newport Beach State: CA ,Zip: 92663
Prope tyowner: Michelle Bacarro zip code:
Owner Address: City:
State: CA Zip Code: Home Phone:
Owner's Authorized Agent: Work Phone:
Agent Address: City:
State: �� Zip Code: Agent Email Address:
Escrow Company: Freedom Escrow I Escrow #: 054091 -MM
Escrow Address: 1200 Newport Center Dr., Suite 180 City: Newport Beach
State:CA ( Zi Code: 92660 Escrow Phone:
Zip (949)644-3939
Email Report to. I..W���.......... ...... •Wf°y
For Inspection call (Name): N/A Direct Phone:
I authorize insp
violations are d
Owner/Agent's s
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
Account # 01050504-521040 ................. Make checks payable to: CITY OF NEWPORT BEACH
Building Dlviv.a \Forms\RBR J-30-20