HomeMy WebLinkAboutR2021-0205 - Permit Application-
City,df `dewport Beach ONNUNIrY
COMMUNITY DEVELOPMENT DEPARTMENT OEVELOPMarl
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-89MAR 18 2021
yi7g �2 s�yg A� www.newportbeachca.gov j (949) 644-3200
RBR# @` Ia9Y Uel/ :;ITY OC
Application for Report of Residential Building Reco
# of Units Address:
1213
Property Owner:
Owner Address:
Please type or print and complete all information
City Newport E36CYta Sate GA'; Zip:
Zip Code:
City
Home Phone: '
State. = Zip Code:
Owner's Authorized Agent TiPri Carr J Work Phone:
Agent Address 1:4O.Neh✓p4rt;Cptel Dr;#1p0,° ......,' > City:
State. � Zip Code. 'i92t360 ' " ''s 6r'!z Agent Email Address:
Escrow Company. r`anite Esorow Settyment.etvlce��i ,';, Escrow #:
Escrow Address:
City:
State CA= ,
Zip Code 9660 a..3 .,:'
Escrow Phone:
Email Report to.
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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