HomeMy WebLinkAboutR2024-0018 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION RECEIVED By
COMMUNITY
100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA92658-891`9EVELOPMENT
RBR# �20 Z4 - ow www.newportbeachda.gov (949) 644-3200
JAN 16 2024
Anolication for Report of Residential Buildine Records
# of Units: Address:
Please type or print and complete all information
City: Newport Beach State: EZip:
1�. 1iyr(p
Property Owner: �vd� IyS,tim ,v ,r Zip Code:
Owner Address: 00 Lkvt Mt City: �fJWpQ�� ,�p�
State: CA Zip Code:Home Phone:
b°,
Owner's Authorized Agent: Work Phone:--�
Agent Address: City:
State: Zip Code: Agent Email Address:
Escrow Company: ( *C Escrow #:
Escrow Address:�� CRy:
State: Lb�-} Zip Code: Escrow Phone: -
Email Report to: I \ W (/y..W1 (/1,'�,�n O _ � 4 (y� �t {%J "tL� ,y!�C(W ` VVV
Forlrfspection call (Name): IntAW \� V1 AV(-LV DirectK3Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
Account # 01050504-521040 .................Make checks payable to: CITY OFNEWPORT BEACH
Bullding__DivlslanVormARBP_5-15-22