HomeMy WebLinkAboutR2021-0247 - Permit Applicationci�CEiVEG 1;Y
City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT nEVELCiPMEN 1
BUILDING DIVISION APR 0 2 2021
IV 100 Civic Center Drive P.O. Box 1768 1 Newport Beach, CA 92658-8915
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� VL www.newportbeachca.gov 1 (949) 644-3200
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Application for Report of Residential Building Records 1�01P�IQa7
Please type or print and complete all information
# of Units- .Address 1r51Crt
_. YSateZip:
Property Owner:
Owner Address:
State: = Zip Code:
Home Phone:
City:
Owner's Authorized Agent Mann"telltrra. in F�r £ Work Phone:
Agent Address:
State: � Zip Code:
Escrow Company:
Escrow Address:
Agent Email Address:
City:
City:
Zip Cade:
Escrow #:
State +' :
Zip Code 92i6Q . _I; r
Escrow Phone: (99}
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Email Report to
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For Inspection call (Name) rpt„.� t Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED AND DATED BELOW
Account # 01050504-521040........�ke checks payable to CITY OF NEWPORT BEACH