HomeMy WebLinkAboutR2021-0811 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT NOV 3 021727
BUILDING DIVISION
100 Civic Center Drive i P.O. Box 1768 1 Newport Beach, CA 92658-8915
I UuI/� �Y/lIrv;r
www.newoortbeachca.eov i (949) 644-3200
RBR# 0;`.
Application for Report of Residential Building Records
Please type or print and complete all information
# of Units: M Address 1 l?qe WillarsCity .)[i kv ort ESeash.::,,.;.:; Sate M Zip
Property Owner:
Owner Address:
State Zip Code:
Zip Code:
City:
Home Phone: 12_ : _........... ...r_= --
Owner's
Owner s Authorized Agent gig (Toot;; Work Phone:
Agent Address:sidaOnve
Zip Code:
,__..:m_
Escrow Phone
City
Email Report to
fiffon
State GA...._:
Zip Code:
9266(1 =
Agent Email Address:
I wz _
Escrow Company. iGramte EscrmN &;St,;eEscrow #:
Escrow Address .;;4SQ,:llew "Ce" .......: ........6a . .t._._... City:
State =CA ...m;
Zip Code:
's":5680...., ,:.._:- ...
Escrow Phone
; 9d9 72ti=QLIR _. ;. ,
Email Report to
fiffon
"randeesq Wcollt.....,
For Inspection call (Name) .. =: Direct Phone:
CONSENTTO INSPECT (FORM MUST BE SIGNED AND DATED BELOW
Account # 01050504-521040 .................. Make checks payable to CITY OF NEWPORT BEACH