HomeMy WebLinkAboutR2020-0926 - 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# r`wto' 0*12OV
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: 1339 Hampshire Circle City: Newport Beach State: CA Zip: 92660
00211-1ED 9),
Property Owner: Steven C. King and Am,, SStoody Kinq com"11mr,
Owner Address: - City: 00 2 R[GD
State: -Zip Code: - Home Phone:
Owner's Authorized Agent: Valerie Vichikov Work Phone:
Agent Address: Airway Ave B, City: Costa Mesa State: CA Zip Code: 92626
Mobil Phone: - Agent Email Address:
Escrow Company: Mariners Escrow Escrow # 59510 -RB
Escrow Address: 270 Newport Center Drive, Suite 200
State: CA Zip Code: 92660
Email Report To: rbuenrostro@marinersescrow.com
For Inspection Call (Name):
City: Newport Beach
Escrow Phone: 949-640-6040
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
violations are discovered I will be responsible to correct said violations.
Owner or Agent's signature to authorize inspection
M
Owner or Agent's signature to decline inspection
D - 2 7-20?0
Account # 2900-5005 ................. Make checks payable to CITY OF NEWPORT BEACH