HomeMy WebLinkAboutR2020-0906 - Permit ApplicationPrint Form City of Newport Beach°1`I as
COMMUNITY DEVELOPMENT DEPARTMENT .:OMNAUNITY
BUILDING DIVISION IDF..VELOPMEN1
100 Civic Center Drive P.O. Box 1768 1 Newport Beach, CA92658-8915 (OCT 2 ® ZOZO
RBRffp ZO20 — 0906 www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records t TYOF
Application Fee: $194.00
Notice: .I,F.I k�C2ga-r 3<.0
(For All Residential Buildings) Applications with insufficient fee payment
Reinspection Fee $129.00 or incomplete will be returned
Please type or print and complete all information
#of Units: F— Address: 1835 Port Taggart Pl City: Newport Beach State: Zip: 92660
PropertyOwner] _ Zip Coder
Melinda A. Grubbs
Owner Address: 1835 Port Taggart Place City: FNewport,Beach
State; FC`— Zip Code: 192660 Home Phone: 19493137333
Owner's Authorized Agent: I Sara Taylor Work Phone: I 949-717-7100
Agent Address: 1400 Newport Ctr Dr --- City' Newport Beach
State: CA Zip Code: 02660 Agent Email Address: staylor@surterreproperties.com
Escrow Company: I Corner Escrow
Escrow Address: 131706 S. Coast Hwy, # 302
State: F CA Zip Code: Fq2651
Email Report to:I donnas@cornerescrow.com
For Inspection call (Name): NA
Escrow#:I #07 -8611 -DS
City; ILaguna Beach
Escrow Phone: 949-313-7333
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/Agent's signature to authorize inspection:
Date:
OR , D
Owner/Agent's signature to decline inspection: / �.,ti�` -, -Date: F/ro Z -J
G l
Account it 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
Bvilding pla0lon\Forms\RBR_7-30-20