HomeMy WebLinkAboutR2021-0061 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
www.newportbeachca.gov 1 (949) 644-3200
RBR# (Z9-0 Z 1 -000
Application for Report of Residential Building Records
Application Fee: $194.00 Notice: Applications with insufficient fee
payment
Reinspection Fee $ 129-00 or incomplete will be returned
Please type or print and complete all information
# of Units: -1— Address: 1969 Port Dunleicth Circle City: Newport Beach State: CA Zip: 92660
Property Owner: Robertson Family Trust under Trust Instrument dated March 29 1994 as amended and restated May 19.
2004
Owner Address: - City:
State: _ Zip Code: _ Home Phone:
Owner's Authorized Agent: -- Work Phone:
Agent Address: _, City: _ State: CA Zip Code:
Mobil Phone: _ Agent Email Address:
Escrow Company: Mariners Escrow
Escrow Address: 270 Newport Center Drive, Suite 200
State: CA Zip Code: 92660
Email Report To: rbuenrostro@marinersescrow.com
For Inspection Call (Name):
Escrow # 59952 -RB
City: Newport Beach
Escrow Phone: 949-640-6040
Direct Phone:
CONSENT TO INSPECT (FORM MU5T 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 1 will be responsible to correct said violations.
Owner or Agent's signature to authorize inspection
OR
Owner or Agent's signature to decline inspection
24-zoz
Account # 2900-5005 ................. Make checks payable to CITY OF NEWPORT BEACH