HomeMy WebLinkAboutR2021-0391 - Permit ApplicationGE1Vfq a
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COPAfLlUNIYY
City of Newport Beach DEVELOPMENT
COMMUNITY DEVELOPMENT DEPARTMENT MAY 2ej 202,
BUILDING DIVISION
100 -Civic ~„enter Drive I P.Q.,BoX.1768 1 Newport Beach, CA 92658-8915
Www.neaortbeachca.eov ( (949) 644-3200 CITYOP
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Application for Report of Residential Building Records>PENCI
Please type or print,and complete all information
of Units: 'M Address 43 NaInOtStteai .,. _ti z.. _ , Ci Nevi od Bemgh..;t Sate 0 Zf
Property Owner. Se bi5s lfaeritiatan, TTgafae zst.3hc aerounian€(Fa l rriYst
_ ,....... 21p Code
Owner Address r d IVainut ., T :.:...::x;. j,...._...'.: a _;., City ;.New _rt egoh.
State AAs ,, ,in Zip Code:
Horne Phone: �_..,.
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Owner's Authorized Agent-,..Ale"`aYI amain %ab Work Phone (49) 63651 0.;i
Agent Address x:.341 Baysideprt�ze.... .::: { City_ `:tde niiBeach
State OI�,._.w Zip Code Bft, ._. m'm _.... Agent Email Address _ arida fan tptrt as:oom ....._:
Escrow Company 'Orant(a.1 e r. W.,atent Sgiaaca..__ _ . s,g .. _., °.......". :.., ., :
Escrow
Escrow Adr3ress :r" li<
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State _GA Zip:Code
.g. ,Ot _...._ ,. _., Escrow Phone: -. tl
'SCI=C} I lti. ..... :........_ _.. .
Email Report to. "zYton
For inspection call (Name)'11211-1111-_.._
` k Direct Phone
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CONSENT TO INSPECT (FORM MUST BE SIGNED AND DATED BELOW `
Account # 01050504' 52T040 ..-....,..Moke,chec*s peyabte#n CITY pf NEWPORT BEACH