HomeMy WebLinkAboutR2021-0348 - Permit ApplicationPrint Form City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
Q11'00
„���� �� 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
RBR# CCr�(J � 0 www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
Application Fee: - $194.00 Notice:
(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
Y CA 'Zip. _.92663 L.
# of Units: 'Address: 2300 L Lille Lane #214 City: New ort Beach State: 'i
PropertyOwner:i Mark Berwick
Owner Address:
State:CA _ _-.-_ Zip Code: --- - -
Owner's Authorized Agent: Work Phone:
Agent Address: City:
State: F Zip Code: F Agent Email Address: j
Escrow Company: Freedom Escrow Escrow #: 054605 -MM
Escrow Address: 1200 Newport Center Dr., Suite 180 City: Fewport Beach
State:CA Zip Code: F92660 Escrow Phone: (949) 644-3939
Email Report to:mm@ freedomescrow.COm
For Inspection call (Name): N/A 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
Owner/Agent's signature to decline inspection: -�j�� ,� A%,, r i gy Date: I "Ay S &.Zt
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
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