HomeMy WebLinkAboutR2022-0086 - Permit ApplicationCity of Newport Beach A,cl�1v111 pry.
COMMUNITY DEVELOPMENT DEPARTMENT COMMUNITY
BUILDING DIVISION DEVELOPMENT
� n1 J,v f i � 100 Civic Center Drive P.O. Box 17681 Newport Beach, CA92658 h$��5c� ZOZZ
RBR# VU v U[ www.newportbeachca.gov (949) 644-3200
Application for Report of Residential Building Records CITYOF
Please type or print and complete all information
#of Units 1 'Address: 1310 Kln S ROad City: Newpch State: nZlp: 82863
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Property Owner: Rodney K Millen & Shelly Lyn Campbell Zip Code:69413
Owner Address: 176e us Hwy so City: FZnbrook
State: CA Nevada i Zip Code: ,89413 Home Phone: 7143134567 i
Owner's Authorized Agent:
Agent Address: .,
Work Phone:®®_ —
City: _.__.-------------------
State:Zip Code: F Agent Email Address:
Escrow Company: THE ESCROW SOURCE I,� Escrow # 9818 -SM
ESCfOW Address: 27611 La Paz Road, Suite D City: Laguna Niguel, j
State: -__ . OA_____ Zip Code:92677 .........i Escrow Phone: [E
Email Report to: ( sheiby@theescmwsourm.net
For Inspection call (Name): i Direct Phone:—®)
CONSENT TO INSPECT (FORM MUST BE SIGNED 8, DATED BELOW)
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
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