HomeMy WebLinkAboutR2021-0778 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
�jnA 1 I / (JM 100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA92658-8915
RBR# 'c //U C l' www.newportbeachca.gov j (949) 644-3200
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# of Units: i Address: MUS.. �iVZY\�e. City: Newport Beach ' State: CA Zip:"I�»CO�D i-------------
PropertyOwner: (,\fr -^�— Zip Code:
Owner Address: City:EC3C.__.._._................... - .a
State: CAA _ — Zip Code: - `� L�4 Home Phone: `j
Owner's Authorized Agent: Work Phone: --------------
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Agent Address: i City:
State:j Zip Code:
Agent Email Address: 1
Escrow Company: (.%l l U t _S,CY O.V .... ........ ---........ .. _.-_........_.-_.......__.._I Escrow #: OS ii �= Z% _
Escrow Address gZ17 W�\S\\S�City:
State: C (aCA Zip Code: Y`� tTZ\i— Escrow Phone:
Email Report to:
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For Inspection call (Name): Direct Phone:
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CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
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