HomeMy WebLinkAboutR2021-0399 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
RBR# W www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
Please type or print and complete all information
#of Units: �7 Address: �tid ,�iS 1tV� City: Newport Beach State: CA Zip:�2
PropertyOwner: ��w(�� I _ Zip Code: �
Owner Address: City:
State:CA _ Zip Code: C� \ Home Phone:
Owner's Authorized Agent: r wua Work Phone: - -%
Agent Address: "--//fit City:
State: j Zip Code: F-77-71 Agent Email Address:
Escrow Company: LCKIrA_ Escrow #:
Escrow Address: I _ Acm*�V 0y, City: I Nhk) I ek h
State: ��' Zip Code: ffu"I Escrow Phone:
Email Reportto:
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 Division\FOrmAR0R_7-3040