HomeMy WebLinkAboutR2020-0311 - Permit ApplicationDocuSign Envelope ID: 3E55DBF2-1177-418F-9FDD-CA704770BD1E
�<;CEIVEI� Q.
iemt°Form City of Newport Beach COMMUNITY)
COMMUNITY DEVELOPMENT DEPARTMENT )rVELOPMENT
BUILDING DIVISION MA 'E t� 2020
g� 100 Civic Center Drive I P.O. Box 1768 I Newport Beach, CA92658-915'
RBR#�UpW- JI( www.newportbeachca.gov 1(949) 644-3200
CITY Or
Application for Report of Residential Building Rear- S Fr
Application Fee: - $191.00 Notice:
(For All Residential Buildings) Applications with insufficient fee payment
Reinspection Fee $129.00 or incomplete will be returned
Please type or print and complete all information
# of Units: Address: 132..Sidney Bay Drive City: Newport Beach State. CA j Zip: 92657...
Property Owner: Kenneth and Mary Konopa
Zip Code: 92657
Owner Address: 1132 Sidney Bay Drive City: �-Newport Coast
State: CA
Zip Code: 92657 Home Phone: 949-236-6092
Owner's Authorized Agent: IJason Bradshaw
Agent Address: 840 Newport Center Dr., Suite 100
State:CA Zip Code: 92660
Work Phone: 949-433-3001
City: Newport Beach
Agent Email Address: Jason@bradshawresidential.com
Escrow Company: Lighthouse Escrow, Inc. Escrow #: 019868 CG
Escrow Address: 2355 Main Street, Ste 130 '.. City: Fine '..
State: CA Zip Code: 92614 Escrow Phone: 1 949-236-6092
Email Report to: I chrisann@lighthouseescrow.com
For Inspection call (Name): I Jason Bradshaw Direct Phone: 1 949-433-3001
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
I authorize inspections and re -inspections of the property listed above. I understand that if Building or Zoning
violations are discovered I will be responsible to correct said violations.
Owner/Agent's signature to authorize inspection:
Date:
OR
Doeuftned by:
Owner/Agent's signature to decline inspection: � Date: 3/26/2020
`— E9265A55ME412...
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
Bui1dinV0ivision\Forms\RBR9-1818