HomeMy WebLinkAboutR2020-0543 - Permit ApplicationCity of Newport Beach �:cCEIV ) el
COMMUNITY DEVELOPMENT DEPARTMENT (=OMMUNITY
BUILDING DIVISION IEVELOPMENI
100 Civic Center Drive I P.O. Box 17681 Newport Beach, CA929�$-891 2
RBR#0020
� N�� �6�4� www.newportbeachca.gov 1 (949) 644-3200 LL
Application for Report of Residential Building Recordsyor
Application Fee: - $191.00 Notice: �F6"/ ORT 8016e1
(For All Residential Buildings) Applications with insufficient fee payment
Reinspection Fee $129.00 or incomplete will be returned
Please type or print and complete all information
6 Veranda v: p
�' State: CA 'tip: 92657
# of Units: 1 Address: Cit New ort Beach
Propertyowner: John Geiss and Nicole Geiss Zip code: 92657
Owner Address: 1_6Veranda City: Newport Coast / Newport Beach
State: CA ',, Zip Code: 92657 Home Phone: S- —31 0,n -,T
Owner's Authorized Agent: Paul DaftarlarlWork Phone: 7114-865-5.969-..---,-------'I _...-
Agent Address: 3653 E. Coast Hwy. City:Corona Del Mar
--- --. - .
State: F CA Zip Code 92625 Agent Email Address: Paul@daftarlangroup.com
Escrow company: Prominent Escrow Services Escrow #: 06
Escrow Address: 170 Newport Center Drive #150 i city: Newport Beach
State: F CA Zip Code: 92660 Escrow Phone: 1 949-258-9107 !,
Email Report to: steph@prominentescrow.com
For Inspection call (Name): 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 or Zoning
violations are discovered I will be responsible to correct said violations.
Owner/Agent's signature to authorize inspection:
Owner/Agent's signature to decline inspection:
Buildin�Dlvlslon\Forms\RBR_9-18-18
Date:
a
Date:
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH