HomeMy WebLinkAboutR2021-0200 - 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
RBR# 1-� ` W D www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
Please type or print and complete all information
# of Units: Address 7� '�-7 I Cit Newport Beach State: CA
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PropertyOwner:
Owner Address: _ City:
State: CA Zip Code:
Owner's Authorized Agent:
Agent Address:
State: j Zip Code:
Zip Code: F
Home Phone:
Work Phone:
City:
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Agent Email Address:
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Escrow Company: �lv��LYYI L�L,Yc'.i.� Escrow #:
Escrow Address: City: N��Lj i�CiC
State: ��'� -.,'. ( Zip Code: 94i( (' Escrow Phone:
Email Report to: �OC��CVCS2G�U(11�r Ve:crY\ _i �)n� CYt Y�CM� (6L-0' C For Inspection call (Name): Direct Phone: h; q
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
Account # 010SOSO4-S 21040 .................Make checks payable to: CITY OF NEWPORT BEACH
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