HomeMy WebLinkAboutR2021-0478 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
F�o�� /y U-1 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
RBR# E U j IV www.newportbeachca.gov 1 (949) 644-3200
lication for Report of Residential Building Records
Please tvpe or print and complete all information
# of Units: Address:
1� pp 5e�k� ea
. City: F ewport Beach
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State: CA Zip: a-
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Property Owner: �Gw� nrC ---
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Zip Code� Gq
Owner Address: ��00
(3a FYor�k
City:
State: CA
Zip Code:
Home Pone:
Owner's Authorized Agent:
Work Phone:
Agent Address:
City:
State:
Zip Code:
E-71
Agent Email Address:
Escrow Company: rp�.! Escrow#: QSLI�J% 3W
Escrow Address; I l QO r F ('efv re. 9r. City:
State:17 Zip Code: c{Rl.efe Escrow Phone:
C
Email Report to: Jv`__� ( irn C�CfOW . (:Uyy\
For Inspection call (Name): Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
Building Divlsion\Forms\RBR 7-30-2