HomeMy WebLinkAboutR2021-0305 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
00 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
RBR# 1�`w UV -J www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
Please type or print and complete all information
# of Units: FTI Address: 14 Sidney Bay Drive City: Newport Beach State: CA ,Zip: 92(j5]
Property Owner: Michael Gutman'.. Zip Code: C777
Owner Address: City:
State: F77-71 Zip Code: Home Phone:
Owner's Authorized Agent: Work Phone:
Agent Address: City:
State:
F7---7AgentCode: Agent Email Address:
i
Escrow Company: Freedom Escrow Escrow #: 054568 -MM
Escrow Address: 1200 Newport Center Dr., Suite 180 City: Newport Beach
I
State: FCT777, Zip Code: 92660 � Escrow Phone: (949) 644-3939
Email Report to:mm@freedomescrow.com
For Inspection call (Name): N/q Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
Account # 01050504-521040 .................Make checks payable to: aTY OFNEWPORTBEACH
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