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City of Newport Beach `AN 2 G RECD
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915,`y_ -
pp (%� www.newportbeachca.goy 1 (949) 644-3200
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Application for Report of Residential Building Records
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Owner's Authorized Agent .. ;a ,y ;' .. jIP tV'Work Phone:
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Escrow Company:
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For Inspection call (Name)
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Escrow #:
CONSENT TO INSPECT (FORM MUST BE SIGNED AND DATED BELOW
Account It 01050504-521040 .................. Make checks payable to CITY OF NEWPORT BEACH