HomeMy WebLinkAboutR2021-0302 - Permit Application�ecelvC(t e
City of Newport Beach COMMUNITY
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION APR RECD
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
RBR# �! V L www.newportbeachca.gov 1 (949) 644-3200 per* DEVELOPMENT<`
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Application for Report of Residential Building Records �O'O NEWPOP�
Please type or print and complete all information
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#of Units: Address: YY�L}�
PropertyOwner: `+...S.N.AF.k'-`___.__..,......_____._-�........,.�...,-..., Zip Code: 12.1F'Z.CJ, f
Owner Address: 2f "�AzlCtOLj ,4.Vr. Qty
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State: CA -� Zip Code '2(n2 L3 Home Phone: qt�G� 2 r 2 Gf S 3
Owner's Authorized Agent: Work Phone:
Agent Address: i City:
State: F Zip Code: _ _ _ �� Agent Email Address: j
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Escrow Company: ITrC.. E' Escrow #: 3�i - i "I (e
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Escrow Address: j 4�ltCf{tlk2i0 ` City:
State:- �l Zip Code: 2 O( Escrow Phone:
Email Report to:
For Inspection call (Name):
_m Direct Phone:-�
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
Ufl&g_DivWon ..ARBR-7d0-20