HomeMy WebLinkAboutR2024-0083 - Permit ApplicationCity of Newport Beach RECEIVED BY
COMMUNITY DEVELOPMENT DEPARTMENT COMMUNITY
BUILDING DIVISION DEVELOPMENT
y� 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA9265NO1155 2024
RBR# `�2VyUi' 0��3 www-newportbeachra.gov 1 (949) 644-3200
CITY OF
Appfication for Report of Residential Building Recorft'rOPTgc!�r,?,
Please type or print and complete all information
# of Units: ❑ Address: 13,
1. Vi'� NM -a - ` City: Newport Beach State: ElZip:
Property Owner: C G8 U ovVtIUt 'wj Zip Code:
Owner Address: MH3 N(AA J0 Web be, Gr�Jr city: wort- ICJe1 wyv
State: CA Zip Code: va�� Home Phone:
Owner's Authorized Agent: Work Phone:
Agent Address; City:
State: Zip Code: Agent Email Address:
Escrow Company: LAO � j Escrow #:
Escrow) Address:
�ly�� 'NaJ�.Jr C(M,., tUl� City:
State: Zip Code:
rr�WA�lliNQ Escrow
YTPP�honate-:u� I 99—joa ilr—UA.
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Email Report to: Low -
For
Idspection call (Name): Direct Phone: � I
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW
authorizelnsp¢ to , ns and're-inspections of the property listed above. I understand that if Building or Zoning
violations are cl!covered l will be responsible to correct said violations
x
Owner/Agents signature to authorize inspection
Date:
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
Building RMs1on\Forms\RBR_6-15-22