HomeMy WebLinkAboutR2022-0056 - Permit Applicationn i City of Newport Beach �, cl-lvEo a ,
COMMUNITY DEVELOPMENT DEPARTMENT COMMUNITY
BUILDING DIVISION DEVELOPMENT
RIO 00 �r 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA9265B-TV2022
RBR# llllll www.newportbeachca.gov 1 (949) 644-3200 ��ttttiS @i
Application for Report of Residential Building RecordBYOF
Please type or print and complete all information
F-1.,�._.\ I /-� I /11'� v �S City:
New Beach State: [CA .,Zip: F -!„SJ-%
# of Units: Address: V S l l L� t r IIL��777 U
PropertyOwner: i �L i Zip Code:
Owner Address: +
City:
N .B Ch
State: Zip Code: QD l.& Home Phone: F.
Owner's Authorized Agent: I Work Phone:
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Agent �rAddres�s. %��..1...i 1...GO ' `+_ 1.,.-`� ---SJ� City .1 v C?..%/�I , _ _..... ........ _..
State: �m_.l \..,. o ! Zip Code Ag�e�o�Email N1
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Escrow Company: ..._ �.. ..{� l /��� S 1, ro V V .....,, Escrow #• O ("�'...... — 4 y.....o- V
Escrow Address: (—�- O _ N -e W 51 r"� . City: _N-e..�.0 p I.'i- �..' QC..R'.)
State: FCZip Code: aDOUO F�Y��hi--fir Escrow Phone: 9.4 q cam. QL.f. 13
Email Report to: � �.... �._�. lel CD CI r._QYi I 1....�' "�`'..SC rQ.._w • r.Q ry )..........
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For Inspection call (Name):N I,QiDirect Phone: I I L %} p
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)