HomeMy WebLinkAboutR2021-0795 - Permit ApplicationLUZ1— l q
City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
/�/� BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-891&OV a 7 2021
RBRff �` _1 www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
Please type or print and complete all information
# of Units: 17 Address: 1 M50 Fort Cr 11' T P' . City: Newport Beach State:nZip: 260
Property Owner:
Zip Code: 9260
Owner Address: q50 p0 t qr l�f PIS City: "Ort each ---1
State: CA Zip Code: 2100 Home Phone: 2(0 6225 J -V-IQL
Owner's Authorized Agent: pllul��/�y�/��I/r�Q('� �/ pWork Phone:1`1`49-935-01(08.5�
Agent Address: �oO �Crtylll�'I/��'-4��1� Ste City: [MV In� + __
State: FOA77 Zip Code: a�D(o Agent Email Address: IM18PAu
Escrow Company: 5 �r ,/�(�_ S/G�rpow�/'1�p /,� 'j'I�'�Esscrow#: O — W
Escrow Address: 3500 Wromm 1 Kw7 slV lvt/, City: _Tmay `ne /_ �I
State: _. C � j q2(0Zip Code: 2ro�0 Escrow Phone: 0 - 2- '1200
Email Report to: L' I,I UV I (QI�XA 1%YAF-VJ'0W•D1 -\ ------ �
For Inspection call (Name): J� _ Direct Phone:
CONSENTTO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
Buildin�Division\Forms\RBR_7-1-21