HomeMy WebLinkAboutR2021-0442 - Permit Application (2)City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
W U i '� j
�J-0 ./f 100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA92658-8915
RBR# U www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
Application Fee. $191.00 Notice:
(For All Residential Buildings) Applications with Insufficient fee payment
Reinspection Fee ',$129.00 or Incomplete will be returned
Please type or print and complete all information
#of Units Address: �r ��l m / ,___.._) City: Newport Beach State: CA Zip: C' G a
.... �_.. a 111............______222222 L t._/ t`J
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Property Owner: it/+ 1r'' -r.. _ T. f'"U..S^ p �y IZip
� Code:
Owner Address: _. C7_I- -- I C't—. 4 City:
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State: CA _! Zip Code: .._�_1 4�.`�' � � �� I � Home Phone: 1 N]
Owner's Authorized Agent: /'�-�G,^/h�� r.n-e Work Phone: N1 —s
Agent Address: City:
State:'; Zip Code:
.g2 -(Q (� U Agent Email Address:
Escrow Company:rG.nl ,-�.S_Crlry ...,.,.. Escrow#:I
Escrow Address: 145 City: .N-euoP,0E-J— a .-G.Ck)
State: FD�-- Zip Code: CI-.GI.C� 6�-�Y' Escrow Phone: �_ 2`-t
Email Report to:
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For Inspection call (Name): N t a Direct Phone: I
CONSENTTO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
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