HomeMy WebLinkAboutR2021-0402 - Permit ApplicationCity of Newport Beach Omr,?UNrr„
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION ��gg
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-891YAY i 7 2021
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RBR# f www.newportbeachca.gov 1 (949) 644-3200
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Application for Report of Residential Building Recordsi;,,
Please type or print and complete all information
# of Units. EM Address o3fPla d .....;:m,.,„__,
n City _tJewpo?i_BeaPh._'.; Sate CA.. Zip
Property �YOwner
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Zip Code
Owner Address
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State #
Zip Code..;x, 3 `: Home Phone: t'
Owner's Authorized AgentLK !w:.,.... } , „ Work Phone
Agent Address
145 gLla�t St eetySte',t1br3 ; City:lewport
State: A ,s
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Zi p Code F w_.7._.: Agent Email Address: kp2rfze@morYaetmCg cAMP,,:
Escrow Company:
oahlte scrgw” ' Sai#lert3ent'Sei apes .mm ii:, to 10L„ Escrow #:
Escrow Address
4$QI1Wti;t
eiif Drive, St�ite_6a0 ,r; �n,..m.:: `,.,. L .City.
:i lewPArt;Beach. '
State OA _-;1
Zip Code
,92660 _ ..,_ s-
Escrow Phone:
Email Report to:
For Inspection call (Name) _,n,.,a . .m.. ; m iF i° Direct Phone x .__ `.,;:.,._ .
CONSENT TO INSPECT (FORM MUST BE SIGNED AND DATED BELOW
Account # 01050504-521040 .................. Make checks payable to CITY OF NEWPORT BEACH