HomeMy WebLinkAboutR2020-0327 - Permit ApplicationDocu l§W—& lopeiD: CF76DFED-B2B4-4710-9D41-99D46FF23B73
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COMMUNITY
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APR 17 2020
Print Form City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION CITY OF
100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA 92658-895
RBR# ,� www.newportbeachca.gov (949) 644-3200 NPO
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Application for Report of Residential Building Records
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: 226 Sapphire Avenue City: Newport Beach State: CA Zip: 92662
Property Owner: William Howard Miller and Patricia Carolyn Miller
Owner Address:
State: CA
Zip Code:
City:
Home Phone:
Zip Code:
Owner's Authorized Agent: Brian Gibney Work Phone: (949) 717-6000
Agent Address: 450 Newport Center Dr., Ste. 100 City: Newport Beach
State:CA Zip Code: 92660
Escrow Company: Key Escrow, Inc.
Agent Email Address:
Escrow # 004547 -BR
Escrow Address: 450 Newport Center Drive, 230 City: Newport Beach
State: CA Zip Code: 92660 Escrow Phone: (949) 698-1960
Email ReportTo: brandi@keyescrow.com
for Inspection Call (Name):
Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
violations are discovered I will be responsible to correct said violations.
Owner/ Agent's signature to authorize inspection: Date:
Owner/ Agents signature to decline inspection: Date:
that if Building or
4/14/2020
Account #2900-5005........... Make checks payable to CITY OF NEWPORT BEACH