HomeMy WebLinkAboutR2021-0235 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
RBR# IL G www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
Please type or print and complete all information
#ofUnits: Address: '�� !'�1\�2., City: New Beach State: CA Zip: �� a
Property Owner: �0 c� C�i V ry r c Zip Code:
Owner Address: �,�, �Q,�1 �J� City:0.'�0�.
State: CA Zip Code: " I�dp Home Phone:
Owner's Authorized Agent: Work Phone:
Agent Address: City:
State: �) Zip Code: Agent Email Address:
Escrow Company:iQQ.cTd ti Escrow #: QS LIS I�. -'TW
Escrow Address: I Mo V�Qift.,,-CZ..._ �Y _UlkCity:
State: c—A Zip Code: 9b �_ Escrow Phone: ALIc
Email Report to:
For Inspection call (Name):1. Direct Phone.
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
Buildin�Division\Fmms\RBR 2-30-20