HomeMy WebLinkAboutR2021-0810 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
V/�,� �' ��/ I D 100 Civic Center Drive P.O. Box 1768 Newport Beach, CA 92658-8915
RBR# V Y/ www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
Please type or print and complete all information
# of Units: I I Address: p 1 I P" -City: Newport Beach State: CA Zip:
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PropertyOwner: 11,,,, lip Code;
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Owner Address: .._._...� ______._. I m, _. �j'.'p. - r - ....._ lti ......I, v T W. port .... 3.3 s-1 ........... i
State: CA Zip Code: Home Phone: F
Owner's Authorized Agent: i� V Work Phone: �----��✓�/
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Agent Address: City: N 7C W P Q r -t-- Bch
State: ___CO -11, Zip Code ��
Ag ent Email Address: �
Escrow Company: f ...G.....h lie �5.....�� G...W Escrow #: O��t"
Escrow Address: -t- w
770
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State: 1 7 / 1 �,.., Zip Code �. a ���� QrEscrow Phone: C) y.G
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Email Report to: ,-Tf-)nnvw=dI,Pl.1 ( (,A r n Lni'--c o r
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For Inspection call (Name): -NV�4 q ( Direct Phone:/1
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)