HomeMy WebLinkAboutR2022-0166 - Permit ApplicationCity of Newport Beach coNmUMTo
COMMUNITY DEVELOPMENT DEPARTMENT MAR v J R D
BUILDING DIVISION
7V 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
RBR# w www.newportbeachca.gov 1 (949) 644-3200 CEVELC'NIENT fj 'I' Application for Report of Residential Building Records er r levl'c��
Please tvpe or print and complete all information
#ofUnits:._...
Address:
City: Newport Beach '. State:
CA Zip:
Property0wner:
via dal I(Q 1
Zip Code: (rt�C
Owner Address:
;
city: �� I ►'j
State: CA
Zip Code: Z(e�
Home Phone:
Owner's Authorized Agent:
Work Phone:
Agent Address:
City:
State: 177777
Zip Code:
Agent Email Address:
Escrow Company: q�. t, Escrow #
Escrow Address: �ZW N� ^�"l J City: Neee�pa
r
State: FTA�- Zip Code: ® Escrow Phone: I jL '& %r/
q 3
Email Report to:
For Inspection call (Name): Direct Phone: 1——
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOWI
Account # 01050504-521040 ................. Make checks payable to: CITY OF NEWPORT BEACH
Building Division\Forms\RBR-7-1-2 I