HomeMy WebLinkAboutR2023-1053 - Permit Application (3)City of Newport Beach RECEIVED BY
COMMUNITY DEVELOPMENT DEPARTMENT COMMUNITY
DEVELOPMENT
BUILDING DIVISION
too Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-q%'O 19 2023
RBR# R�JD23 �� 053 www.newportbeachda.gov 1 (949) 644-3200
CITY OF
Application for Report of Residential Building Record sNEWPORTBEACH
Please type or print and complete all information
# of Units: ❑ Address: Roub 'j 09V,01 G PA/t City: Newport Beach State: CA Zip:
Property Owner. ��� `QQ� Zip Code: F1Z�Z.s
Owner Address:. _ ��.`_. IM VAvv jlty AM— City:
State: CA Zip Code: MT Home Phone:
Owner's Authorized Agent: �— I Work Phone:—�
Agent Address: City:
—71
State: � Zip Code:17
Agent Email Address:
Escrow Company: C ovo Val Escrow #: I
's UQ 01ilo
Escrow Address: V�� '�� W J. - "Cy.} City % N �&VILUA/n
State:® Zip Code: -I — To Escrow Phone:
Email Reportto: I \N NWU/AyA aLK0 -"vv�- bV OV kNCG"^tJWYOW Lvyl
For Inspection call (Name): Direct Phone:—�
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOWI
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
0u11dh olv6.*.r-AR00_&15-22