HomeMy WebLinkAboutR2021-0263 - Permit ApplicationRF_CFj�,O
City of Newport Beach 004ryUN7�Y°�
COMMUNITY DEVELOPMENT DEPARTMENT qPR ,
BUILDING DIVISION V 9F�U
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92&8
RBR# 12 ��'" (J 2G,3 www•newportbeachca.gov (949) 644-3200
Application for Report of Residential Building Records RT as c�
Please type or print and complete all information
#of Units: Add5 Tesoro
Address: City: Newport State: . Beach' CA 'Zip: 92657
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PropertyOwner: Constance Wyatt _ _ _.. _.._i Zip Code: F^
Owner Address: 2183 Cardiff Circle i City: El Dorado Hills j
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State: CA Zip Code: 95762 Home Phone 916-803 4246
Owner's Authorized Agent: S., Work Phone: N._.I... n
Agent Address: � City:.... N-.0 pD..r-T T�-P..o.. CT)
State: F_... Zip Code V Agent Email Address:
ijEscrow Company: --- 1......._I ) . _. _/' , l-�/Sr..(�lJ-- I--- Escrow # .... v.....1 . . �T 111�2LJ LJ
Escrow Address: _._ N -e.� ...V �� City ! _. N R_(`
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State: 7� Zip Code: q� (Rgo `----eY 1 - 0 1— Escrow Phone: q �-'i q S3 _L -I' 13
Email Report to: a o r) (!.ili 1.. c) t'L
For Inspection ca\I"1-(1VJIame): _ Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
Account # 01050504-521040 .................Make checks payable to: CITYOF NEWPORT BEACH
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