HomeMy WebLinkAboutR2021-0347 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
�G2(roI 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
2
RBR# C www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
Please type or print and complete all information
# of Units: Address: 204 7th Street City: Newport Beach State: nZip:
92661
Property Owner: The Kenneth C. Jacobs & Eileen C Jacobs Trust dtd 7-19-1996 Zip Code:
Owner Address: 204 7th Street City: Newport Beach
State: CA Zip Code:92661 Home Phone:
Owner's Authorized Agent: Work Phone:
Agent Address: City:
State: � Zip Code: I Agent Email Address: 17
Escrow Company: Freedom Escrow Escrow #: 054609 -MM
Escrow Address: Ll200 Newport Center Dr. #180 J City: I Newport Beach I
State: F7CA Zip Code: 92660 Escrow Phone: i 949-644-3939
Email Report to:F 7-
mm@freedomescrow.com
For Inspection call (Name): N/A Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
violations are discoverec
Owner/Agent's signature ti
Bd1dm,Dw1,r.n\Forms\RBR 9-18-18
m0b,e responsible to correct said violatidns.
uthotize inspection: Date:
OR
2clineinspection ° �Y e Dater
T �T_
Account 4 UIUSU5U4-5Z104U .................Make checks payable to: CITY OF NEWPORT BEACH
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