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HomeMy WebLinkAboutR2022-0071 - Permit ApplicationCity of Newport Beach COMMUNITY COMMUNITY DEVELOPMENT DEPARTMENT DEVELOPMENT BUILDING DIVISION 160 Civ JEB 14 2022 civic Center Drive I P.O. Box 1769 1 Newport Beach, CA 92658�89 RBR#: wwW.n6wportbqachca.gov 1 (94g)644-,3100 CITVnr Please, type or print and Complete all Information 4 of Units: zip� . . .. .... . .......... 16111th"e.' M'W-ekad' I'd Carl s*gor w6i f Property Ownert �Zjilqdd Code: ii - I.. — IT ipi.lm i; tfafed September,, " Owner Address: Owners Authorized Agent; 0—.�—..i..; .n Work Phone. R 9401 Agent Address,,04ta 5 E_._..:....r.1! i Q� N -N, RE E State:, Zipfode: Agent Email Address; iimls, mp ,Xi area es A h. Escrow Qompany; 11-G Escrow #: 1,11,10,44 Escrow Address: statef Email Report to: Escrow Phone-, rim- .......... For Inspection call (Name)Direct Phone:: H.- fit CONSENTTO INSPECT (FORM MUST BE SIGNED AND DATED BELOW Account # 01050504-521040..._._.......... Make checks payable to CITY OF NEWPORT BEACH Bufth#_DivismnTsMf�_74-21