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COMMUNITY
APR -9 RECD
Print Form City of Newport Beach
O DEVELOPMENT
COMMUNITY DEVELOPMENT DEPARTMENT d`
BUILDING DIVISION �
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915 Op Nt::WPOO
RBR# �IJIr 2r�i h www.newportbeachca.gov 1 (949) 644-3200
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Application for Report of Residential Building Records
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: 125 East Bay Front City: Newport Beach State: CA Zip:
Property Owner: Cunningham Family Trust
Owner Address:
State: CA
Zip Code:
Owners Authorized Agent: Steve High
Agent Address: 450 Newport Center Dr., Ste. 100
State:CA Zip Code: 92660 Agent Email
Escrow Company: Key Escrow, Inc.
City:
Zip Code:
Home Phone:
Work Phone: (949) 717-6000
City: Newport Beach
Escrow # 005463 -BR
Escrow Address: 450 Newport Center Drive, 230 City: Newport Beach
State: CA Zip Code: 92660
Email ReportTo: brandi@keyescrow.com
for Inspection Call (Name):
Direct Phone:
Escrow Phone: (949)698-1960
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:
Owner/ Agent's signature to decline inspection: rSh�.-i fti�.. Date:
Account #2900-5005 ..... ...... Make checks payable to CITY OF NEWPORT BEACH