HomeMy WebLinkAboutR2019-1128 - Permit Application~
City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
l0UCivic Center Drive |P.O.Box 17b8|Newport Beach, C/\9Z6S8-891S
| /949\ 644'3I00
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Application for Report of Residential Building Records
Please type or print and complete all information
#ofUnits: E7]Address: city. Sate: zip:
Property Owner: I tvlfdhadl:'G��'�661dst6in and1lene B. Goldstein",
Zip Code:
Owner Address:
City:
State:
Zip Code:
Home Phone:
Owner's Authorized Agent:
Work Phone:
Agent Address:
City:
State:
Zip Code:
Agent Email Address:
EyonowCunopuny:
Escrow #:
EouruvvAddraoo:
Qty:
State:
Zip Code:
Escrow Phone:
Email Report to: jmdmiIIan@dnniteescr6w.'com -7
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For Inspection call UVome\: Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED AND DATED BELOW
Account # 01050504-521040 .................. Make checks payable to CITYOF NEWPORTBEACH