HomeMy WebLinkAboutR2022-0028 - Permit Application181171 V1621-0070
City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT tyecEivEp 6y
BUILDING DIVISION COMMUNITY
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915y'FVELOPMENT
www.newportbeachca.gov 1 (949) 644-3200 JAN 19 2022
Application for Report of Residential Building Records
Please tvpe or print and complete all information
# of Units. 0
"_...::
Address "'
__::1'5�GhUb�C<5 DnVe=._jia�;� !..._.:......
City:
Ci mfla�y =dtTBaaoit_.....;.:
Sate C}r.,.. Zip
Property Owner
Ga-_I#.Fatd' e...T..rusteebif6e"Av.Zip Code
Address
MOROwner
-:.:... ... ':,,� .:-:: ::..;;.:.� . .:_.:.... .:.. City
r w
State '..m.
Zip Code :..:.___.: r;:Rt=.. „,
Home Phone: INS a
Owner's Authorized Agent: Wdffi y $artie7d _,_ ,: U ,0 - 5 .... ,., _ ,;.a; Work Phone:
Agent Address: 50,i*1e—YVpodwCe#1teC.t1#100: City:
State C/..._.; Zip Code x7160 ; a._:.ma...; Agent Email Address: C
Escrow Company .®G'(ahit
Escrow Address 45f;ltie
State: E(;Am Y;id Zip Code:
Email Report to arks[
Escrow Phone:
City:
Escrow #:
For Inspection call (Name) Direct Phone .
CONSENT TO INSPECT (FORM MUST BE SIGNED AND DATED BELOW
Account # 01050504-521040 .................. Make checks payable to CITY OF NEWPORT BEACH
BuildingDivisionTonnsIRBR 7-1-21