HomeMy WebLinkAboutR2020-0484 - Permit Applicationf Form City of Newport Beach t,OMIAUNITY
COMMUNITY DEVELOPMENT DEPARTMENT nEvel.OPi IEE
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 I Newport Beach, CA92658-8jf5' y
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RBR# �. Z O`f Q�� www.newportbeachca.gov 1 (949) 644-3200
CITY OF
Application for Report of Residential Building Records
Application Fee: - $191.00 Notice:
(For All Residential Buildings) Applications with insufficient fee payment
Reinspection Fee $129.00 or incomplete will be returned
Property Owner:
Please type or
print and complete all information
#of Units:
Address:
City: Newport Beach State:
CA Zip: 92625
607 Dahlia Ave.
Property Owner:
Zip Code: F
Dahlia Dei
Mar
LLC
92625
Owner Address:
607 Dahlia
Ave.
City:
Corona
Dei.
Mar
State: CA Zip Code:. 92625
Owner's Authorized Agent: I Jennifer Thomas
Agent Address: 1400 Newport Center Dr. #100
State: FCA Zip Code: 92660
Escrow Company: I Blue water Escrow, Inc.
Escrow Address: I 1400 Newport Center or #125
State: CA Zip Code: F 92660
Email Report to: I jason@bluewaterescrow.com
For Inspection call (Name):
Home Phone:
Work Phone: 949-717-7100
City: I Newport Beach
Agent Email Address: I jthomas@surterreproperties.com
Escrow #:I 20 -6984 -JM
City: I Newport Beach
Escrow Phone: 949-478-7900
Direct Phone: F -
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 l will be responsible to correct said violations.
Owner/Agent's signature to authorize inspection:
OR
Owner/Agent's signatureto decline inspection: Jennifer Thomas
BulldlnH Division\FormskRBR 9-18-18
Date:
Date:
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH