HomeMy WebLinkAboutR2021-0841 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
Z , 1100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
RBR# v"" www.newportbeachca.gov 1 (949) 644-3200
Annlirntinn fnr RPnnrt of Residential Building Records
Please type or print and complete all information
# of Units: Address: n ' City: Newport Beach State: FCA ga.(p(1 `5
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Property Owner: �&fk,U13 Zip Code: C({aCaCo`3
Owner Address: O�(oCo'd, C feSAY,ne. Dr. City: E2UJeoc-a- C3eg(-h.......—_...._
State: CA Zip Code: Home Phone:
Owner's Authorized Agent: �— Work Phone:
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Agent Address: City:
State: —�i Zip Code: Agent Email Address:
Escrow Company: �' - Escrow #:
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Escrow Address:/ City: IJEw�c�r \2j�G,C.b�
State: C Zip Code: ,2(,. (p� Escrow Phone: �1a'Ct_(oc�o(_3gi
Email Reportto: I ' LJ (k).+ {.ed4+ c-,Scrz�Lj ( )/-n -
For Inspection call (Name): ! Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)