HomeMy WebLinkAboutR2022-0030 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
� � I��I,IlO 6 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
RBR# 1(/ G I� V if www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
Please type or print and complete all information
# of Units:F Address; L2E5 i 2 G I 0r —City: Newport Beach State: CA Zip: 2
PropertyOwner V V n G _ {----/�� Inn I ( 1 . �-i— - Zip Code:
Owner Address 2 4� CiLID \J --ern
State: CA Zi Code: q 1 U L Home Phone:
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Owner's Authorized Agent: �- �J Q f n Work Phone: I C/
Agent Address: _� (� r.. O,r Gi— 2 _ I? I _ city:
State: �i Zip Code: 1 q7Q of gent Email Address: I V J
Escrow Company: &-m 1 1,4.. ..Lx .. Escrow #: I O'�._ (( (,,....2
Escrow Address: 4 0 r-+- City: �T lJ `} .
State:_.C� Zip Code: a p �r Escrow Phone: 1 Q4 G
Email Report to:
For Inspection call (Name): i Direct Phone:
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CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)