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HomeMy WebLinkAboutR2021-0248 - Permit ApplicationM s City of Newport Beach COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915 20 /1 /C/'► www.newportbeachca.gov 1 (949) 644-3200 RBR# (�"�`� Application for Report of Residential Building Records ,��pEIVEb @l. 110MUNNiTY m.V-1. C, MEN7 APR 0 2 2021 X71"iY01' .I/OjpORT bb' Property Owner: L3:W.v]A wv�ali�aYfc�vatii iiva4++P4GU tS _..... , Zip Code: Owner Address Please type or print and complete all information State a Zip Zi Code # of Units. M Address . (_Islaf�idst? ; "'Emil City1M#otC Beacta _:.,; Sate: FW Zip. (Name): Property Owner: L3:W.v]A wv�ali�aYfc�vatii iiva4++P4GU tS _..... , Zip Code: Owner Address 0,ITS, _.tet:: zr _i__.' .:°i Escrow Address i) City: State a Zip Zi Code -:a,3� �i�� �i Home Phone: irFeriill Owner's Authorized Agent: Agent Address 12DDt State: 4 Zip Code: Escrow Company: bit( Escrow Address State: Fs � � Zip Code: Email Report to irFeriill For Inspection call (Name): Work Phone City Jewpnrt Hench u Agent Email Address: Escrow #: City: Escrow Phone: Direct Phone: CONSENT TO INSPECT (FORM MUST BE SIGNED AND DATED BELOW Account # 01050504-521040 ............. (.... Make chile to CITY OF NEWPORT BEACH