HomeMy WebLinkAboutR2021-0190 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
R24zj _ /�/jq® 100 Civic Center Drive P.O. Box 1768 1 Newport Beach, CA 92658-8915
I` www.newportbeachca.gov 1 (949) 644-3200
n for Report of Residential Building Records
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# of Units: \ Address: City`New ort Beach State:❑ZiP
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Pro ertOwner: LLV7....-_...._-.........-E'��1�%-�
Zip Code: 7-7
Owner Address: - City: - _ -._
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State: CA iJ Zip Code: Home Phone: -
Owner's Authorized Agent:
Work Phone: i�`.1.(�J'-� 1�
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Agent Address: City:
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State. �! Zip
Code F7 Agent Email Address:
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Escrow Company: - ..� 1`/,
P Y� Escrow#:
Escrow Address:
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State: � Zip Code: Escrow Phone: ��-�1� •_�,���
Email Report to: I-vC \wS�_�.!_tXJL1Y..V-4`/V_�/ I, --------- ------.J
For Inspection call (Name):-_ - _�-_ _ Direct Phone: -
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
Account # 01050504-521040 .................Make checks payable to: CITYOF NEWPORT BEACH
BuildinRDivision\Forms\RBR_7-30-20