HomeMy WebLinkAboutR2021-0565 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
F70 J_ p Vl� ,p q 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
I L �! www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
#ofUnits: I I Address;IC
P roperty Owner:I(
Owner Address:
State: CA Zip
Please type or print and complete all information
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Owner's Authorized Agent:D-TKJ�j
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State:
City: Newport Beach State:
City:
CA.. iZip:�/�`
Work Phone:! ! ..... _....
Email Report to:
For Inspection call (Name):
Building_Dlvlslon\rn MARBR_9-18-18
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH