HomeMy WebLinkAboutR2020-0540 - Permit Application' xuSign Envelope ID: EB9E21A9-3544-40F5-B615-D1C6CB467AOE
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City of Newport Beach ey
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COMMUNITY DEVELOPMENT DEPARTMENT C )EV
BUILDING DIVISION
�1n' 100 Civic Center Drive ( P.O. Box 17681 Newport Beach, CA 92658-,N0 0
RBR# IAV '� 5 (4o www,newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records aTYOF
Property Owner. t/ `._ .-,""� Zip Code; -
Owner Address:. City:
State; FC7A7-7] Zi Code:
P -� Home Phone: L - -----
Owner's Authorized Agent: �{.-- Work Phone: .
Agent Address:
L City;1 L6 -
State:C�- ZIp Code:176� q 2,(p� Agent Email Address:
Escrow Company:
Escrow Address:
State: HT
Email Report to:
For Inspection call (Name): Direct Phone: — 7
CONSENT TO INSPECT (FORM MUST BE SIGNED &DATED BELOW)
Account # 010513504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
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Please type or print and complete all information
# of Units: F71 Address:
City [Newport
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State: Zip:
Property Owner. t/ `._ .-,""� Zip Code; -
Owner Address:. City:
State; FC7A7-7] Zi Code:
P -� Home Phone: L - -----
Owner's Authorized Agent: �{.-- Work Phone: .
Agent Address:
L City;1 L6 -
State:C�- ZIp Code:176� q 2,(p� Agent Email Address:
Escrow Company:
Escrow Address:
State: HT
Email Report to:
For Inspection call (Name): Direct Phone: — 7
CONSENT TO INSPECT (FORM MUST BE SIGNED &DATED BELOW)
Account # 010513504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
W➢dIn�ONbiw\Farms\RBR_918-3H