HomeMy WebLinkAboutR2020-0523 - Permit ApplicationDocusign Envelope ID: F6F406EF-103A.47AA-A598-159F699FD33A
COMMUNITY
OEVEI-OPMENT
PrntForm ;;; City of Newport Beach JUN 2 9 2020
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
�� •bC24100 Civic Center Drive P.O. Box 17681 Newport Beach, CA926`SI6Y89i15
RBR# 7 ✓ www.newportbeachca.gov 1 (949) 644-3200 n✓ Off'
PORT BEP
Application for Report of Residential Building Records
Aoolication Fee: - $191.00 Notice:
(For AIIResidential 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: I—
Address: 77 Ebb Tide Circle City: Newport Beach State: CA Zip: 921 663
Caruso Family Trust
Owner Address: 104 Monarch Bay Dr.
State: ICA Zip code: 192629
Owner's Authorized. Agent: Meital Taub
Agent Address: 1900 Glenneyre St.
State: FGA Zip code: 92651
Zip Code: F92663
City: i
Dana Point
Home Phone: 949-313-7333
work Phone: 1949-922-9552
city:I Laguna Beach
Agent Email Address: I meital@taubproperties.com
Escrow Company: I
Corner Escrow
Escrow Address: 31706 S. Coast Hwy, # 302
State: ICA ZipCode:l 92651
Email Report to:
donnas@cornerescrow.com
For Inspection call (Name)
Escrow #:I 07 -8263 -DS
City:I Laguna Beach
Escrow Phone: 1949-313-7333
Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
1. 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
Do"c/IuSign�e'd b�y:�'`�
Owner/Agent's signature to decline inspection: EiLLI(�P.f.l. (AMS6 Data;
FCC7117MEE4ea...
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
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