HomeMy WebLinkAboutR2022-0203 - Permit ApplicationR B R # aS_ildl�Z"3
City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT�� EIVEO �!
BUILDING DIVISION COMMUNITY
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915 'IFVELOPMENT
www.newportbeachca.gov 1 (949) 644-3200 APR 13 2U22
Application for Report of Residential Building Records
Please type or print and complete all information
# of Units: M Address aw
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Property Ownerarralne O EE3rn�rd�r, a5 T(ifs �� of th EX�(�� I n TYc Ypf ��t�' �rriard� TrG� ,
p Y DIY+ d Aenu� 5 lg8Q i �, f E Zip Code
Owner Address. . , ...... r e e
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State Zip Code:?a 2 s ,(, `; Home Phone:
Owner's Authorized Agent 1""aa Work Phone:
Agent Address:
State � Zip Code:
City:
Agent Email Address: faNf?uff@dol dpm,
Escrow Company n�G)--sc'r.'o$;,�u l`rnenf�r(. r t i Escrow#:
_k v A_se PCF .S't i. epysii;M aw.,..
Escrow Address P ����. tr(f rid ui"�0 ,r', c �, u �� 9t °" ' f City:
State '-.0
Zip Code.la0r„
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Escrow Phone:
Email Report to
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For Inspection call (Name):
Direct Phone
CONSENT TO INSPECT (FORM MUST BE SIGNED AND DATED BELOW
OF NEWPORT BEACH
Building_ DivislonWonnslRBR_7-7-21