HomeMy WebLinkAboutR2022-0149 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
rn 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
RBR# �- 0 H—gU� www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
Please type or print and complete all information
#of Units: IJP Address:�UC (jy' � City: .Newport Beach ,� State: CA Zip:gZ v
Property Owner: CV1 ke,:� 6L SLk.%,py� ,.� Zip Code:
Owner Address: �� /huah4k4(.cl `vim City: I N p OCQ
State: CA Zip Code: R Home Phone:
Owner's Authorized Agent: ( Work Phone:
Agent Address: City:
State: C� Zip Code: Agent Email Address:
Escrow Company: ��G— �I�,y �,n / d ° Escrow #:
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Escrow Address: 1,200. Newpor+ C+r W— l TD City: �P,u�,Oo
State: F lI Zip Code: ' gZ�� Escrow Phone:
Email Report to:
Far Inspection call (Name): Direct Phone
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
Account # 01050504-521040 .................Make checks payable to: CITYOF NEWPORT BEACH
Buildin,DiV,w\Forms\RBR 7-1-21