HomeMy WebLinkAboutR2022-0159 - Permit ApplicationCity of Newport Beach iECEIVED &k
COMMUNITY
COMMUNry DEVELOPMENT DEPAkTMENT DEVELOPMENT
BUILDING DNISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915 MAR 2 3 2022
RBR#�20WIM www.newportheachca.gov 1 (949) 644-32D0
Application for Report of Residential BuildingRecords CITY OF
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Owner Address
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Owner's Authorized Agent
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Escrow Company: i •r �� �� 1� f Escrow 0: —M G ' (?62,
Escrow Address: 12.O O Cev�•ter Y n `�ty % '�
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Email Report to: D {, fi G l�v�Q.(.}-We,)}e.SC.r•OW • C�w�
For Inspection call (Name}: F Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW
hauthorize Inspections.andce=ii'Spection'sof•the proPeriy fisted above. I understar ckfratif B'uildingorZoning.
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Owner/Agentsignature•toauthonize•inspection: DECLINED Qa��L
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Owner/AgeaC'ssigncature•1n deciineinspecGinc�:
Account # 010S0504-521040.................Make checks payable to; CITY OF NEWPOftr BEACH
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