HomeMy WebLinkAboutR2021-0771 - PermitsPrnor., Y p
Cit of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
(n BUILDING DIVISION
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n V100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
RBR# I I www.newportbeachca.gov 1 (949) 644-3200 �;y 0-
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Application for Report of Residential Building
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Please type or print and complete all information
#of Units: F Address: 5 Stargazer_ City: Newport Beach j State: CA ',;Zip: g2657
Property Owner: Shakeal Masoud Zip Code:
g2657
Owner Address: 5 Stargazer City: FNewport Coast
State: CAS Zip Code: 92657 Home Phone: 3107594-5167
Owner's Authorized Agent: rShiva Ommi, Broker Work Phone: 949-887-6737
Agent Address: 15 Highpoint city: Newport Coast
State: FEA Zip Code: 92657 I... Agent EmailAddress: ShIVBOmmI@gmalLCOm
Escrow company: Generations Escrow _ _ Escrow #: 401-41754-sg
Escrow Address: 32451 Golden Lantern #300 j City: Laguna Niguel
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State: CA Zip Code: FiT677 Escrow Phone: 949-373-8800
Email Report to: sgifford@genescrow.com
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For Inspection call (Name): Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
Buildin�DIvlslon\Forms\RBR J-1-31