HomeMy WebLinkAboutR2020-0889 - Permit ApplicationDocuSign Envelope ID: 49FC7E9B-9FFD-42AD-AD3C-9F51 E4558293
Print Farm City of Newport Beach 00 14 ZON
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
tZI)_Oc/Gp 100 Civic Center Drive I P.O. Box 17681 Newport Beach, CA92658-8915
RBRq U A 1 www.newporlbeachca.gov i (949) 644-3200
Application for Report of Residential Buildine Records
Application Fee: - $191.00 Notice:
(For AIIResidential Buildings) Applications with insufficient fee payment
Reinspection Fee $129.00 or incomplete will be returned
Please type or print and complete all information
N of Units: Address: 417 Harding St City: Newport Beach State: CA Zip:9261
Propertybwner. Zip Code:—
The BRCS FamilyLimited Partnershi
Owner Address:31441 Via Consuelo City:.
Trabuco Canyon'
State: ICA Zip Code: I 92679 Home Phone
Owner's Authorized Agent: I Michael Caruso Work Phone: I 949-584-2300
Agent Address: 331 Foothi.11 Road Suite 100 City: Beverly Hills
State: CI A Zip Code: 99 01 210 Agent Email Address:
michael.caruso@theagencyre.com
Escrow Company: Escrow #:
orner Escrow 07 -8564 -DS
Escrow Address: 31706 Coast Hi htaa City:
#302 f Laguna Beash
State: Com— Zip Code: 926551 Escrow Phone: 949-313-7333
Email Report to:
For Inspection call (Name):
@cornerescrow.com
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 orZoning
violations are discovered I will be responsible to correct said violations.
Owner/Agent's signature to authorize inspection:
Date:
OR
�Docusigned by: .
Owner/Agent's signature to decline inspection: 1 9 1'�S(.� Date:.
83902Ea75ACD0 ...
Account If 03U505U4-521040................. Make, checks payable to: CITY OF NEWPORT BEACH
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