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COMMUNITY
OEVELOPMEN1
Print Form City of Newport Beach MAR 16 2020
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA 92658-8915
RBR# i ` .,V www.newportbeachca.gov I (949) 644-3200 CITY OF
Application for Report of Residential Building Record` OPT W'
Application Fees: Single Family Res/Condo (lunit)-$165.00 Notice:
Duplex (2 Units) -$192.00 Application with insufficient fee payment
More than 2 units - $192.00 + 11.00 per unit over 2 or incomplete will be returned
Reinspection Fee $88.00
Please type or print and complete all information
# of Units: Address: 15 Tribute Court City: Newport Beach State: CA Zip: 92663
Property Owner: Echo
Owner Address:
State: CA
LLC
Zip Code:
Owner's Authorized Agent: Kristina Heimstaedt
Agent Address: 450 Newport Center
State:CA Zip Code: 92660
Ste. 100
Agent Email Address:
Zip Code:
City:
Home Phone:
Work Phone: (949) 717-6000
City: Newport Beach
Escrow Company: Key Escrow, Inc.
Escrow Address: 450 Newport Center Drive, 230 City:
State: CA
Zip Code: 92660
Email Report To: corina@keyescrow.com
for Inspection Call (Name):
Direct Phone:
Escrow # 004518 -BR
Beach
Escrow Phone: (949) 698-1960
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:
3/16/2020
Owner/ Agent's signature to decline inspection: Date:
Date:
Account #2900-5005........... Make checks payable to CITY OF NEWPORT BEACH