HomeMy WebLinkAboutR2022-0036 - Permit Application�EkveD 9),
OOMMUNrIY
City of Newport Beach 05\1ELOPMSKr
COMMUNITY DEVELOPMENT DEPARTMENT JAN %4 nzz
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8 91�5oF
rvV (iii �l www.newportbeachca.gov (949) 644-3200
PORP P'
Application for Report of Residential Building Record eE
# of Units: FI Address:
Please type or Print and complete all information
City: Newport Beach j State: Zip: q (oC�
PropertyOwner:,UT, A..__, ?Q- .-fr__� Ir_-__�� Zip Code: FT
Owner Address: City:—_—�
State: CAI - Zip Code: �� Home Phone:
Owner's Authorized Agent: ` I h h Co I f'\ _ i Work Phone: II ----�\� I—
Agent Address:
__9� �Q_ N -ew p c r-�- City: N C GIS
/( rr�e� _ ..... _...........
State: -� I Zip Code: G _... lL lJh P �/ .... ....
2 � Agent Emai Address:
-. .......... ...
Escrow Company: _ r Escrow#: y- —l�. ! .. f, l 0
Escrow Address: _Lt-_._...__ city:__.
ew or+NQ
C-C—r 1 - Pr 5�
State: / Zip Code:1, 2� -b p (-- �+c Escrow Phone: q 9 Cr 1�
Email Report to: I UD Q r) f) -e I I -eq rp Q r- a h i -f— E, ,-(f- S Cf, Q
For Inspection call (Name): N 1 Direct Phone:
71
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
Account # 01050504-52104.\....�/�MAe-e4cks payable-to!CITY OF NEWPORT BEACH
Bui1d1n,_B1v1sion\F0rms\RBR 9-19-19