HomeMy WebLinkAboutR2021-0585 - Permit Application-d'cUVEI) 41,
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City of Newport Beach- EVEL P MEN
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COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION AUG 13 2029
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
www.newportbeachca.sov 1 (949) 644-3200 CITY or
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Application for Report of Residential Building Records ��iwpot�r bl-o�
# of Units Address:
Please type or print and complete all information
City: Sate MXt?.,. Zip
Property Owner: tld G,.R :ataeyocabie,.Trost
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Owner Address i T .. TM it City:
State � Zip Code _',-,m;;,;: Home Phone:
Owner's Authorized Agent
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State CA Zip Code g 0 _ Agent Email Address:
Escrow Company
(Granite Escrow $ ,Sttirrleait Ser rlcas x 4 Escrow #:
Escrow Address
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Zip Code
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Escrow Phone:
Email Report to:
For Inspection call (Name) s iE..... �4 11p...f$° ,....E..t, 4„T;. urs+ �� ,�.,,��� Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED AND DATED BELOW
Account # 01050504-521040 .................. Make checks payable to CITYOF NEWPORT BEACH