HomeMy WebLinkAboutR2020-0551 - Permit ApplicationDocuSign Envelope ID: 7F7BC16E-0676A474-B48A-AD9DADB2FE36
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— City of Newport Beach -* c(MMUNITY
0EVEI-OPMENT
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION JUL 0 7 2020
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
RBR# ZIDTO --(SSS www.newportbeachca.gov 1 (949) 644-3200 1,11"y OF
Application for Report of Residential Building Recordkvpo-r 6�-,W
Application Fee: $191.00 Notice:
(For AllResidential Buildings) Applications witb insuff Iclent fee payment
Reinspection Fee $129.00 or incomplete,will be returned
Please type or Print and complete all information
# of Units: O Address: Park Avenue I City: [Newport Beach l State: CA !Zip:1 92662
Property Owner:Todd Marshall. Keller and Shannon Louise__KI Iler Zip Code:
Owner Address: 10762 -Meads
City:
. .......... -------
State: FCA Home Phone:
Zip Code: F 912869 '1 213-500-0505
Owner's Authorized Agent: Sharon KELak
Agent Address: 1251 E Yo rb a Linda Blvd
Work Phone:
City: Placentia
State:FuZip Code: 70 com
i
77 Agent Email Address: SharonKaaEMkaaJl.
- .. .. ... ... ... .... _ "; L__ . .... . ... ...
Escrow Company: Escrow Options Group i
Escrow#:
Escrow Address: 40100 Rarranca Pkwy Suite 220 city: Irvine
--------------- 1 _ ------ I ....... ____ - ---- - .... .. . ... ..........
State: CA zipcode: 92604 Escrow Phone: 949 783 2430
Email Report to: 1_;Soo ,.MopiafEscrow0p,t,i,owl.,corn
For Inspection call (Name): DECLINED Direct Phone
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 orZoning
violations are discovered I will be responsible to correct said violations.
Owner/Agent's signatureto authorize inspection; AIM Date:
1 DOCU81056.
Owner/Agent's signature to decline inspection: kOAA 41�v Date: 1 6/30/2020
Account # 01050504-521040.................Make checks payable to: CITYOF NEWPORT BEACH
ESCROW
OPTIONS GROUP
City of Newport Beach
100 Civic Center Drive
Newport Beach CA 92658
Attn: Building Divisin
4000 Barranca Pkwy, Suite 220, Irvine, CA 92604
Tel: (949) 783-2430
Fax:
Email: Soo.Moon@Escrow0ptions.com
RE: Seller: Todd Marshall Keller and Shannon Louise Keller
Property Address: 1305 Park Avenue, Newport Beach, CA 92662
In connection with the above numbered escrow, we enclose the following:
Application for report of Residential Building Record—NO INSPECTION
Date: July 6, 2020
Escrow No: 13 -2076 -SM
Once report is ready, please email to Soo.Moon@EscrowOptions.com
We appreciate the opportunity to be of service to you in this transaction. Should you have any questions, please call
us at the telephone number(s) referenced above.
Escrow Options Group, Inc.
Soo Moon
SM
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