HomeMy WebLinkAboutR2021-0443 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
�(��� �s R 100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA92658-8915
RBR# 9•v U www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
Please type or print and complete all information
#ofUnits: IT] Address: jp3 City: Newport Beach State: CA ',Zip:
Property Owner: QA,\(" 5. Cc, tr Zip Code: FDZG
Owner Address: NOS MU4-C16 City: New�or� (jeacln _ _ J
State: CA Zip Code: �m(o(op Home Phone:
Owner's Authorized Agent:
Agent Address
Work Phone: �—
City:
State:i Zip Code: E-71 Agent Email Address:
Escrow Company: fr_e r)cw„� LSGro�,J Escrow#:
Escrow Address: IaOU ��U,t pry- CGnk� 9r. -A City:W,yW --}
State: l /7� li Zip Code: Escrow Phone:
Email Report to: JI•�1�tPae_c�owtiEStrnw coon
For Inspection call (Name): Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
Account # 01050504-521040 ................. Make checks payable to: CITY OF NEWPORT BEACH
Building 0ivision\Forms\RBR 730-20