HomeMy WebLinkAboutR2022-0029 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT 'ACEIVED 6y
BUILDING DIVISION COMMUNMY
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915)EVELOPMENT
Q� www.newportbeachca.gov 1 (949) 644-3200
RBR# ��� � Z I JAN 19 2022
Application for Report of Residential Building Records
Please type or print and complete all information
# of Units: ;s; =°;:
Address
iI, Cfitiba c g, ; w City: Bevy S�r(r '. ach...,;,:; Sate _. zip:
Property Owner
tsars A Eudge; Ttuste nffie Gary p, Fudge Trust uldlt dated January L7
Zip Code
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Owner Address
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State: ;.=
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Zip Code
ti �� ; _ Home Phone: p 9 µ
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Owners Authorized Agent
.Nam" 4i3aif ldr1� .,„�tiW:� ;: UMM ._.�, ,�... e Work Phone F.1
Agent Address
,40DiNe
Cityi>teyyport=Beach :.
State CA;.....r
Zip Code
�2E6A' � _..'.mm...r_... Agent Email Address:
Escrow Company I.tadlt4,twscr$SptflementSerilce5° iu..:.....mw_Mmn—m.!..._ Escrow #:
Escrow Address50tafie„ ortenfer.RhVr Suite 6b..0 .:. :. .... ....a. City:
State t;A..:,,....:
Zip Code.
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Escrow Phone: 1.51.1 � .., _�•
Email Report to
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For Inspection call (Name) ,_ _ _, _, _ , Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED AND DATED BELOW
Account # 01050504-521040 .................. Make checks payable to CITY OF NEWPORT BEACH
Building_DivisionTonnsIRBR 7-1-21