HomeMy WebLinkAboutR2022-0102 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
full 416 L 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
RBR# V� www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
Please type or print and complete all information
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# ofUnits: Address: City: New ort Beach State:
PropertyOwner: 61CA , d- tr XcA—oy,–(A S)ra V; Zip Code:
Owner Address: � AJ Q„ City: 0\ bj ril\n
State: CA Zip Code: `acas Home Phone:
Owner's Authorized Agent: Work Phone:
Agent Address: City:
State: Zip Code: 17771 Agent Email Address:
Escrow Company:..._.;otaOyy\_... �Sc,yovJ Escrow #: 55��% �.....TW
Escrow Address:Cit
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State: CjAZip Code: �j-��'(� Escrow Phone: Q L�"-4q
Email Report to: J W @ F.fQ,Qddyy,, QSr-ynw, rQ4n^
For Inspection call (Name): Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORTBEACH
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