HomeMy WebLinkAboutR2021-0196 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
t I www.newportbeachca.gov 1 (949) 644-3200
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Application for Report of Residential Building Records
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# of Units :,...' Address .8 21!ista'Ba "a r
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Property Owner
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Owner Address:
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Zip Code:
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Home Phone:
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Owner's Authorized Agent
Work Phone
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Agent Address:
City: Newport Beach .. . -
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State: CA:,.)
Zip Code:
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Agent Email Address:,bcolocdic@ylll'arealestat@
Escrow Company: ;,{;tplli)eE§crow,'&:'Settlement 5e"ruices ;r a', Escrow #:
Escrow Address:
State: .� Zip Code:
Email Report to:
Escrow Phone:
City:
For Inspection call (Name): Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED AND DATED BELOW
Account # 01050504-521040 .................. Make checks payable to CITY OF NEWPORT BEACH