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HomeMy WebLinkAboutR2021-0441 - Permit ApplicationCity of Newport Beach COMMUNITY DEVELOPMENT DEPARTMENT ®p BUILDING DIVISION gao �_ 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915 RBRk V www.newportbeachca.gov 1 (949) 644-3200 Application for Report of Residential Building Records Please type or print and complete all information k of Units 17 Address: ��C� h !City Newport. Beach State: CA..:Zip:rPT.._...0..f a3 Property Owner. _._. I i © t� . Q._d o n_o .....1 '_, Zip Code: F ((�� 1 ..... l.'1 V V ..v1 Owner Address: ..,...� L.....4..rt _.. -F=o I qty' State: CA Zip Code: C—Q IY� Home Phone Owner's Authorized Agent:Work Phone: J a_r n -e :; N ---- Agent Address: . 0 r O a--1-- I City: N State: Zip Code: q',. V Agent Email Address: Escrow Company: rG.l....l �, - - Escrow k Oy Escrow Address: N--eW P G r+l City. N 12)cv State: Zip Code D C-6/1 ' ' r' Escrow Phone: q,l,.f q y-13 am\ 2y Email Report to: For Inspection call (Name): N I i Direct Phone: q' CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW) Account k 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH 8u11d1ng D1v1s1an\Forms\RRR 918-18