HomeMy WebLinkAboutR2023-0222 - Permit ApplicationV401436 18OdM3N
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City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION 1N3Wd013A3O
100 Civic Center Drive I P.O. Box 1768.1 Newport Beach, CA 92658-8915 XUt4SV4Vj03
RM OZZ& www.newportbeachca.gov 1 (949)644-3200 a a�a
Application for Report of Residential Building Records
# of Units: =1 Address:
Please twe or print and complete all information
City: Sate: CA" zip..
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Property Owner,Pro Zip Code:
Owner Address:
I City: r
State: = Zip Code:
Home Phone.,
Owners Authorized Agent: John Cain" ::` WorkPhone:
Agent Address: O 1;�Q_N nveSbithlbo' ;:z:! I City: F, Newport Beaph!,:
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A ' Zip Code: 92660 Agent Email Address*
EscrowCompany: Graniterw,
,EsdJo"" &$e#ferhpnt',%rVjdes, � ...... Escrow #: I 0414777JJG---�
Escrow Address: 1-45Q:Newoortr �� :, —
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State: GA' Zip Code: Escrow Phone: (949)720=01'70:';
Email Report to: jdb6hbIIeyj&f6nil:64§cr
For Inspection call (Name): Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGN ED AND DATED BELOW1
Account # 01050504-521040 ....... ....... — Make checks payable to CITY OF NEWPORT BEACH