HomeMy WebLinkAboutR2021-0169 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
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QI 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
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RBR# W (fj www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
Application Feer- $,194.00 Notice-,,,�, .:z
(For'AIIRCsidential Buildings) Applicatians with insufficient fee payment
Reinspection Fee $129.00 or Incomplete will be returned
Please type or print and complete all information
#of Units: Address: 206 Colton Street City: Newport Beach State: CA Zip: 92663
Property owner: The Daniel S. Reich Trust_ _
Zip Code: I
Owner Address City:
State: CA Zip Code: Home Phone:
Owner's Authorized Agent: I Work Phone
Agent Address: I ----. --_-. ----. City:
State: Zip Code: Agent Email Address:
Escrow Company: Freedom Escrow Escrow #: 054440 -MM
Escrow Address: 1200 Newport Center Dr., Suite 180 j city: _.Newport Beach_.__
State: CA Zip Code: 92660 Escrow Phone: (949) 644-3939
Email Report to:mm@freedomescrow. corn '.,.
For Inspection call (Name): N/A Direct Phone:
i
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 l will be responsible to correct said violations.
Owner/Agent's signature to authorize inspection: Date:
OR
Owner/Agent's signature to decline inspection: Date: 3 -CE -v
Account # 01050504-521040 ................. Make checks payable to: CITY OF NEWPORT BEACH
B.,1d1,S_0i U.s \Forms\RBR 7-3020