HomeMy WebLinkAboutR2021-0609 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
1,j0 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
RBR# -U21 a CWGJ www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
Please tvoe or Print and complete all information
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Property Owner. [_SA - Zip Code:
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Owner Address: 4.0 City: ACA—�
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Home Phone:
State: Zip Code:
Owner's Authorized Agent: Work Phone:
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Agent Address:[ ---F"t kztc 49 GV _•_ City:
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State: 170A Zip Code: FYTD l T7 Agent Email Address:
Escrow Company:Escrow
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Escrow Address:
qve. City:
State: Zip Code:Ft rT Escrow Phone6-
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Email Report to:
For Inspection call (Name): I ,o_14_A ',Z
8u11ding_Div!ston\Forms\RBR 7-30-20
Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
Account # 01050504-521040 .................Make checks payable to: ary OF NEWPORT BEACH