HomeMy WebLinkAboutR2022-0077 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
www.newoortbeachca.eov 1 (949) 644-3200
RBR#
Application for Report of Residential Building Records
Please type or Print and complete all information
# of Units I„ E, ; Address:2's . City:
Property Owner:
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City: Address:
State: oi[ I'm is Zip Code:
Home Phone:
Sate. M Zip:
Owner's Authorized Agent. I)4tEy�!itT11a? ! Work Phone:
Agent Address: .Oor dh` e, _ "�aGlfe 9X)On,:.,,9 . 9x ttux F City: E!(1 -w
State: Zip Code:
Agent Email Address:
Zip Code:
Escrow Company: i" _Scrou!%ti&aetttdlttm ides( ,Eary, .Q t„µPp aEr$.., r=r1 Escrow#:
EscrowAddress: 1#609N. �f:,#rt€. n eriOft Si�IW-60{� rr�,a= rr i� g: �`.�`„': x9•`1,4 ,4 City:
State: A
Zi Code:
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Escrow Phone.
Email Report to:
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For Inspection call (Name) j,{=1, , --_F, =`) Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED AND DATED BELOW
Account It 01050504-521040 .................. Make checks payable to CITY OF NEWPORT BEACH
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