HomeMy WebLinkAboutR2021-0480 - Permit ApplicationCity of Newport Beach PLEASE COMPLETE,
COMMUNITY DEVELOPMENT DEPARTMENT SIGN AND RETURN
�{�(� BUILDING DIVISION
�/� O Cb v 100 Civic Center Drive P.O. Box 1768 1 Newport Beach, CA92658-8915
RBR# L (( www.newportbeachca.gov 1 (949) 644-3200 9xt,ro
Application for Report of Residential Buildine Records
Please type or Print and complete all information
# of Units: 'Z Address: .�,2� � city: Newport Beach State: CA Zip:F71�� 3
PropertyOwner:l �.��iaw, k13V(4TrtY2W��� Zip Code: 42`7v5•
Owner Address: J� vlEu City:
State: CA Zip Code: gT-t15 —2+ I Home Phone: 4P4
Owner's Authorized Agent: Work Phone:
Agent Address: City:
State: [� Zip Code: Agent Email Address:
Escrow Company: �<t� D l 2(�, Escrow #: V •—�
Escrow Address:
City:L,r-i,tS"� (�
State: L✓a-�� Zip Code: 4�7�3 Escrow Phone:
Email Report to: I u;�M �' ` ov
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 DIVsi.n\Farms\RBR-7-30.30