HomeMy WebLinkAboutR2022-0011 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Bax 1768 1 Newport Beach, CA 92658-8915
V 1-061 t www.newportbeachca.gov 1 (949) 644-3200
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Application for Report of Residential Building Records
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# of Units Address (,�a +/(Stauai City:
Property Owner:
Owner Address __..:.- m ._rv:::- _.,_'_._..?,:, City:
State: €= m Zip Code:
Home Phone:
Sate CA`,_ Zip
Owner's Authorized Agent s:...i Work Phone:
Agent Address
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City:
State Ct4;
Zip Code: 62 a.:m° ._°
Agent Email Address:
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Zip Code:
Escrow Company Kb',�te,,,_scr1411. ier l7t ersrlges 1,"MM'.-INN., a. .......' Escrow M
Escrow Address:
City:
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Zip Code
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Escrow Phone:
011
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Email Report to
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For Inspection call (Name): '3 y x"s '`'` Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED AND DATED BELOW
Account It 01050504-521040 .................. Make checks payable to CITY OF NEWPORT BEACH