HomeMy WebLinkAboutR2021-0477 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
Q,g—h 100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA92658-8915
RBR# VL cU 1 `� i 6 www.newportbeachca.gov (949) 644-3200
Application for Report of Residential Building Records
Please type or print and complete all information
# of Units: 17iAddress: 10(A0k&nro6 City: ort Beach State: CA Zi
PropertyOwner: SG�1� Zip Code: NPS
Owner Address: ��30 Cto(t5GRV-0 k'ntic, City.
State: CA Zip Code: C(��pp� Home Phone: I
Owner's Authorized Agent:
Agent Address:
Work Phone:
City:
State:j Zip Code: —77 E-7-7 Agent Email Address:
Escrow Company: 1W — — Escrow#:
Escrow Address: �`aOO } cer fcar Dr, * 18'0 City: ea
State: 1_ `may ` Z—ip—Co'rd' e: C{a(p&O Escrow Phone:
Email Report to: gSCAVW Co L �J
For Inspection call (Name): __7 Direct Phone: —
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
Building Dlvlslon\Forms\RBR_7A0-20