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CoMNIUNII'Y
City of Newport Beach r'EVELOPMCNY
COMMUNITY DEVELOPMENT DEPARTMENT MAY 01 2020
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
2/b 9 ,, /� %{ / www.newoortbeachca.gov 1 (949) 644-3200 CITY Or
404,
Application for Report of Residential Building Records
Please type or print and complete all information
# of Units: 0 Address: 4 T7ia Fron ._ City .NeW ori,Beachr Sate M Zip.
Property Owner :r ISN',:. M:oinnFa� [ca �vv.0�u.0
_. _I Zip Code:
Owner Address A-6.17 #a7rfgd nems :., „ y; _ City
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State: _Lr° Zip Code:
Home Phone:
Owners Authorized Agent:_Nollaert)2pse;_,.1s Work Phone ,{7)4);88324Fi3;'
Agent Address:
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City a3uena Park;:,:
State (p,.,.,
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Zip Code m9C20_;
Agent Email Address.
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Escrow Company: Granii Eacl .5ei#Imen# Serilce.._s t a r Escrow #
Address
State A..._ ;
Zip Code
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::92660 , ;
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Escrow Phone: 1`0110-4,11Y
City
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Email Report to
For Inspection call (Name) .,., y _:.. ._._. s Direct Phone
CONSENT TO INSPECT (FORM MUST BE SIGNED AND DATED BELOW
Account # 01050504-521040 .................. Make checks payable to CITY OF NEWPORT BEACH