HomeMy WebLinkAboutR2020-0803 - 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#92a ZO — 00
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:1830 Galaxy Drive City: Newport Beach State: CA Zip: 92660
Property Owner: Big Canyon Inc. a California Corporation
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: djohnson@marinersescrow.com
For Inspection Call (Name):
Escrow # 59289 -DJ
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
Owner or Agent's signature to decline inspection
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Account # 2900-5005.................y..Make checks payyaablle, to, CITY OF NEWPORT BEACH
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