HomeMy WebLinkAboutR2021-0404 - Permit ApplicationDocuSign Envelope ID: 6E8E5938-D60D-4D52-A079-B409CDD192EC
Prim Form City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
tjnn BUILDING DIVISION
�" 0 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
RBRIt www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
Application Fee: - $194.00 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
Nof Units: F_ Address: F129 E. Bay Ave
Propertyowner:j129 East Bay Avenue, LLC
Owner Address:
State: CA Zip Code: F
City: NewportBeach State: CA Zip: 92661
City:
Home Phone:
Zip Code:92661
Owner's Authorized Agent: I Brett Smith Work Phone: 1949-307-3898
Agent Address: 2 Ritz Carlton Dr, Stes. 102, 201-202 city: Monarch Beach
State: CA Zip Code: 92629 Agent Email Address: BrettSmithRE@gmail.com
Escrow Company: ( Corner Escrow, Inc
Escrow Address: 31706 S Coast Hwy, Suite 302
State: CA Zip Code: 92651
Escrow #: 07 -9189 -DS
City: I Laguna Beach
Escrow Phone: 949-313-7333
Email Report to: I donnas@cornerescrow.com
For Inspection call (Name): I N/A Direct Phone: N/A
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
DocuSigned by:
Owner/Agent's signatureto decline inspection: i 9A SmA, Date: 5/27/2021
ll-3s2011311054CDBNA5...
Account N 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
Builling DivislonBonnnABP 7-3620