HomeMy WebLinkAboutR2022-0081 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
n `W li v D @in Z 01100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
RBR# www.newportboachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
Please type or print and Complete all information
#of Units: Address: �'� \ I S' I (L�_S' City: Newport Beach State: Zip: _[J
PropertyOwner: ^Tt < _T m__ G M_ mf„ mI I Zip Code.
Owner Address: city: 8� Cti
N e uu pL
State:CA i Zip Code: Home Phone:
I t G.2 t
Owner's Authorized Agent Q r I .- ' Work Phone: N I
i
yy..,, ...._.___ ,..._ ,._.....�
Agent Address: '.._.�-efy"-ef City: Ir v..i. h e.
State: i Zip Code: a2c.e l.. Agent Email Address: !,
Escrow Company: 11 I o.1...1 r. -i ..-E'S_.CrQL-"�J .......... Escrow#: 04......71'. tj.', i — j-0
Escrow Address: city:�-+
State: FCn Zip Code "12 (P Cj—�i(i'�'�i Escrow Phone: q '4Q Sa a�
Email Report to: V I.Jl�riri'Z�I->°l...l Q Y�/`ov��—I--,�-.o.rrr-r' I /'/n/L,/. J
For Inspection call (Name): v Direct Phone: i
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)