HomeMy WebLinkAboutR2021-0206 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
Ful( -0 2 a 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
www.newportbeachca.gov 1 (949) 644-3200
for Report of Residential Building Records
Please type or print and complete all information
# of Units: � Address: I h A NAy Ltkyp City: Newport Beach State: FZip:�
Owner Address:
State: Zip Code: Home Phone:
Owner's Authorized Agent:
Agent Address City:
State: �� Zip Code: Agent Email Address:
Zip Code:
Work Phone: -I
Escrow Company: Escrow #:
i
Escrow Address: ` � 1�c� y Q�HIM
State: I v \ Zip Code: 7_� Escrow Phone: -
Email Report to:
For Inspection call (Name): I Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
Buliding Division\Fmms\U 2-3620