HomeMy WebLinkAboutR2021-0057 - Permit Application:yCOVF.D By
COMMUNITY
City of Newport Beath !ar.VID OPM ENI
COMMUNITY DEVELOPMENT DEPARTMENT JAN 2 h 2021
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
pp www.newportbeachca.gov 1 (949) 644-3200 (,ITY OF
RBR# n.i,F. Off`
Application for Report of Residential Building Recordi"SRT 5-
Please type or print and complete all information
# of Units: D Address 7_Iv)ati`txpn `. `; `.. , _...:.. ... _:,.._} City. ,;Newport Beach.._'.:: Sate CA_ Zip
Property Owner:
Zip Code:
Owner Address
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City
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Zip 'b50 M Home Phone:
Zi Code: .132 .._..�r,:� 4 ...........::
City.-"NewRortE3eactt
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Owner's Authorized Agent letinlfer Fraze ,.,. ,,
Work Phone
Agent Address
City.-"NewRortE3eactt
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Agent Email Address:
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Escrow Company Grant#esaov(I &F* etr$merlf�Sef�tces. Ra E... sm._.G„ r �.: x _.,;: Escrow #: bA4b�7„-'T_LG 5i'k.
Escrow Address 4O New _or( GeneT Eiji lue,_$ulfe 600. City yNev�po l9each -
State CA ,._,.; Zip Code 9256 , .; ., . ;, Escrow Phone: (94g) 72Q 0170
Email Report to: tgriffon n gEamt# escrdti 4Dm
For Inspection call (Name)%010,, : ,„ fi N” y�ra...,.. , r, _r.c lr Direct Phone. r ! y m ._.
CONSENT TO INSPECT (FORM MUST BE SIGNED AND DATED BELOW
Account It 01050504-521040 .................. Make checks payable to CITY OF NEWPORT BEACH