HomeMy WebLinkAboutR2021-0580 - Permit ApplicationCityof Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT t
6n� ioN
9- 0
BUILDING 811 New
�( (}0 Civic Center (P.D. Bax � 7�8 � Newport Beach, CA 92658-8915
RRR# www.newportheachca:gov1(949)644-3200. _
Pleasetivpe or print and complete all information'
#afUnts: Address:X ! . „ P Ctl: NetiupnrtBeach State:DCA ZiR:1!
State: ZIP Code: ': Home Phone::-
Owner's Authorized Agent;. I.:. Work Phone- `°�' 76' �C..O
Agent Address:rM P - ) � 5 ' Gq'-
ZiPCode: t tY Agent Email Address: �:.�j }/'�(/� ` Oc
Escrow Company 7� Y1 I i1: I Escrow 4k.
Escrowdkddress: W. L+1�'�' $" Y�'1"• i. r
State:,:. Zip Code- u....
�} Fscraw Phone:
Email Reportto;.
For Inspectlon nil {Flame};:
CONSENTTO INSPECT WORM MUSTBE SIGNED & DATED BELOW}.
e�nai��u,�ra,\Fom�+laae >-i n.