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COMMUNITY"
Print Eonr1 City of Newport Beech DEVELOPMENI"
COMMUNITY DEVELOPMENT DEPARTMENT JUL 0 2 2020
BUILDING DIVISION
Oe,,��.t� 100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA92658-8915
RBR#1' VP - 05410 www.newportbeachca.gov 1 (949)644-3200 C11Yof
Application for Report of Residential Building Records `�1111ORT 51-FC1
Application 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
Address: 2 Beleourt Drive — City: New ort Beach I State: CA Zip: 92660
# of Units: 13, J .I e_...-"r�l .— . I
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PropertyOwner: Robert and Diana Ferguson Zip Code I 92660
Owner Address: 2 Bec:ourt Drive city: Newport Beach
State: CA Zip Code: 92660 I Home Phone: 714-421.1405 �I
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Owner's Authorized Agent:Susan sinciair
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Agent Address: 341 Bayalde Drive
Work Phone: 94%697-4144
City:Newport Beach
State:CA Zip Code: 9zsso
i Agent Ercall Address: susanslnclair(a}bhhscal.com
Escrow Company: I North Orange County Escrow I Escrow #: 1 55502000023
Escrow Address:1 Cit
1370 Brea Blvd Suite 110 : Fullerton y
State: CA Zi Code: 9zsso Escrow Phone: ,714-526-5400
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Email Report to: LWm.AbbottQctl.com
For Inspection call (Name): Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
I authorize inspections and re -inspections ofthe property listed above. I understand that if Building or Zoning
violations are discovered I will be responsible to correct said violations.
Own er/Agent's signature to authorize inspection: Date:
Owner/Agent's signature to declineinspection:X ,;,;+Date:"'! / 'j�eT
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