HomeMy WebLinkAboutR2021-0194 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
�/yp�9�t/G-�-M//�� 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
RBR# 'F+ www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
Aoolication Fee: - $194.00 Notice:
(For AUResidential Buildings) Applications with insufficient fee payment
Reinspection Fee $12$.00 or incomplete will be returned
Please type or print and complete all information
# of Units: IT] Address: L2516 - 2518 Bayside Drive City: Newpo l each_ I State: CA_Zip: 92625 —i
Property Owner. Turnbury, LLC
Owner Address: -..i City:
State: CA _ _J Zip Code Home Phone:
Owner's Authorized Agent: Work Phone:
Agent Address: I...... City:
State:F Zip Code Agent Email Address:
Zip Code:
Escrow Company: Freedom Escrow ESCfOW #: 054399 -MM
Escrow Address: 1200 Newport Center Dr., Suite 180 City: Newport Beach
State: FCA Zip Code: 92656 Escrow Phone: (949) 644-3939
Email Report to: I mm@freedomescrow.com
For Inspection call (Name): N/A Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
authorize inspections and re -inspections of the property listed above. I understand that if Building or Zoning
violations are discovered l willi be responsible to correct said violations.
'Owner/Agent's signature to authorize inspection: Date:
OR
Owner/Agent's signature to decline inspection:��l Date: 3 l Z
Account # 01050504-521040 ................. Make checks payable to: CITY OF NEWPORT BEACH
Buildin,DiVi ion\Forms\RBR 7-30-20