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HomeMy WebLinkAboutR2021-0443 - Permit ApplicationCity of Newport Beach COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION �(��� �s R 100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA92658-8915 RBR# 9•v U www.newportbeachca.gov 1 (949) 644-3200 Application for Report of Residential Building Records Please type or print and complete all information #ofUnits: IT] Address: jp3 City: Newport Beach State: CA ',Zip: Property Owner: QA,\(" 5. Cc, tr Zip Code: FDZG Owner Address: NOS MU4-C16 City: New�or� (jeacln _ _ J State: CA Zip Code: �m(o(op Home Phone: Owner's Authorized Agent: Agent Address Work Phone: �— City: State:i Zip Code: E-71 Agent Email Address: Escrow Company: fr_e r)cw„� LSGro�,J Escrow#: Escrow Address: IaOU ��U,t pry- CGnk� 9r. -A City:W,yW --} State: l /7� li Zip Code: Escrow Phone: Email Report to: JI•�1�tPae_c�owtiEStrnw coon For Inspection call (Name): Direct Phone: CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW) Account # 01050504-521040 ................. Make checks payable to: CITY OF NEWPORT BEACH Building 0ivision\Forms\RBR 730-20