HomeMy WebLinkAboutR2021-0268 - Permit Application0CEIVED @Y
COMMUNITY
Print Form City of Newport Beach APR 9 RPC
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
/j 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-88 15 DEVELOPMENT US
RBR# /� i www.newportbeachca.gov 1 (949) 644-3200 �Th IZO*
`)�/`fe OF NEWPORT
Application for Report of Residential Building Records
Application Fees: Single Family Res/Condo Hunit) - $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: 219 Evening Canyon City: Newport Beach State: CA Zip: 92626
Property Owner: Geoffrey L. Stack
Owner Address:
State: CA
Zip Code:
Owner's Authorized Agent: Steve
Agent Address: 450 Newport Center Dr., Ste. 100
State:CA Zip Code: 92660 Agent Email Address:
Escrow Company: Key Escrow, Inc.
Zip Code:
City:
Home Phone:
Work Phone: (949) 717-6000
City: Newport Beach
Escrow # 005459 -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 Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED 8 DATED BELOW)
or
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: Shm A(tir. Date:
Account #2900-5005 ..... ...... Make checks payable to CITY OF NEWPORT BEACH