HomeMy WebLinkAboutR2021-0170 - Permit ApplicationEMMM City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
A QI1 0 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
RBR# www-newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
Please type or print and complete all information
#ofUnits:Address: 916 E. Oceanfront City: NewportBeach j State: CA .Zip: 92661
Propertyowner: Groundswell Investments, LLC Zip Code:
Owner Address: City:
State: CA Zip Code: Nome Phone:
Owner's Authorized Agent: Work Phone: J
Agent Address:) City:
State: Zip Code: �— Agent Email Address:
Escrow company: Freedom Escrow Escrow #: 054449 -MM
Escrow Address: 11200 Newport Center Dr., Suite 180 city: I Newport Beach
State: Cq Zip Code:92660 J Escrow Phone: (949) 644-3939
Email Report to: mm@freedomescrow.com
For Inspection call (Name): 1\I/q 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
violationsare discovered I will be responsible to correct said violations.
Owner/Agent's signature to authorize inspection: Date:
Oft
Owner/Agent's signature to decline inspection: Date:
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
Bulldl,g Division\Forms\RBR 7-30-20