HomeMy WebLinkAboutR2021-0671 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
��/II/,/U� 1100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
RB. r www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
Please type or print and complete all information
#ofUnits: Address: 'J`L� 0� %iVt: City: Newport Beach State: CA Zip:N(
Property
Owner Address:
State: FCA77-7 _ Zip Code:
Owner's Authorized Agent:
Agent Address:
Law. Zip Code: 9��to2
City: ----._--
Home Phone:
Work Phone:
City:
State: Zip Code: �� Agent Email Address:
Escrow Company: Escrow #. 0 -3w —�
_1_YPLtiDM _ Y'O.IJ O �y �
Escrow Address: I 2.00 k4wquA C<.-_ 1 __ Q,.. City: �y
State: l '� l Zip Code: �'� Escrow Phone:
Email Report to: _-W�jFe"—do�nC5crow_Com
For Inspection call (Name): Direct Phone:--�
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
Account # 01050504-521040 ......./,.(.,......Make checks payable to: CITY OF NEWPORTBEACH
Bu11d1ng Div1s1on\Forms\RBR_7-1-21