HomeMy WebLinkAboutR2021-0306 - Permit ApplicationDocuSign Envelope ID: FB66ECC2-068D-4577-8976-1 DABBEA552CE
Print Form City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
O ���� BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 � Newport Beach, CA 92658-8915
RSR# 2 www.newportbeachca.gov (949) 644-3200
Application for Report of Residential Building Records
Application Fees: Single Family Res/Condo (lunit) - $165.00 Notice:
Duplex (2 Units) - $192.00 Application with insufficient fee payment
More than 2 units - $192.00 + 11.00 per unit over 2 or incomplete will be returned
Reinspection Fee $88.00
Please type or print and complete all information
# of Units: Address: 2144 Vista Laredo City: Newport Beach State: CA Zip: 92660
Property Owner: Jonathan Guy King, Trustee of the Jonathan Guy King Trust dated April 22, 2010
Zip Code:
Owner Address: 803 Norco Place
City: Venice
State: CA Zip Code: 90291 Home Phone:
Owner's Authorized Agent: Susie McKibben
Agent Address: 450 Newport Center Dr., Ste. 100
State:CA Zip Code: 92660 Agent Email Address:
Work Phone: (949) 717-6000
City: Newport Beach
Escrow Company: KeyEscrow,lnc. Escrow# 005496 -BR
Escrow Address: 450 Newport Center Drive, 230 City: Newport Beach
State: CA Zip Code: 92660 Escrow Phone: (949) 698-1960
Email Report To: brandi@keyescrow.com
for Inspection Call (Name):
Direct
CONSENT TO INSPECT (FORM MUST BE SIGNED S DATED BELOW)
or
violations are discovered I will be responsible to correct said violations.
Owner/ Agent's signature to authorize inspection: Date:
Owner/ Agents signature to decline inspection:_ )DlnaNiat1. 4;Y,6". Qyv,"ate:
4/22/2021
Account #2900-5005........... Make checks payable to CITY OF NEWPORT BEACH