HomeMy WebLinkAboutR2021-0573 - Permit Application;EC 8(Vfi0 .
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City of NewportBeachAUG 10 ZOZ9
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8P15 Y
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Application for Report of Residential Building Records
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# of Units Address,CVlis"�". City:
Property Owner:
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Zip Code:
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State: � Zip Code:
Home Phone:
Owner's Authorized Agent ImarleNHas3e1NMI _,__ ",4 Work Phone
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State ,types Zip Code:
Agent Email Address:
Escrow Company MEM & ,ernenttY)res il _ ,,t Escrow #:
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For Inspection call (Name) sk _ j..« ,°, ....§ 7 .... ..z(' Direct Phone
CONSENT TO INSPECT (FORM MUST BE SIGNED AND DATED BELOW
Account # 01050504-521040 .................. Make checks payable to CITY OF NEWPORT BEACH