HomeMy WebLinkAboutR2021-0233 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
Z2 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
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J www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
Please type or print and complete all information
It of Units: IT]
Address: 200 McNeil Lane #207 City: [Newport Beach I State: CA Zip: 92663
Property Owner: Harley E. Rouda Zip Code:
Owner Address: City:
---------........-------- ---------
—77
State: CA Zip Code: F777 Home Phone:
Owner's Authorized Agent: Work Phone:
Agent Address: City:
State: Zip Code: Agent Email Address:
Escrow Company: Freedom Escrow Escrow #: 054448 -MM I
Escrow Address: L1200Newport Center Dr., Suite 180 City: I Newport Beach
State: [;A Zip Code:92660 Escrow Phone: 1 (949) 644-3939
Email Report to: mm@freedomescrow.com
For Inspection call (Name): N/q 7 Direct Phone: J
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
I authorize inspections and re -inspections a
violations are discovered I will be responsih
owner/Agent's signature to authorize inspectit
OR
ie'. I understand that if Building
is.
Dati l
8 >R- Date: —J I
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
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