HomeMy WebLinkAboutR2021-0368 - Permit ApplicationPrint Form City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
1C 2� �� —O � & 100 Civic Center Drive I P.O. Box 17681 Newport Beach, CA 92658-8915
RBR# �C 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
It of Units: �' Address: 200 SAPPHIRE AVENUE City: Newport Beach State: CA 'Zip: 92662
PropertyOwner: TOM AND COLLEEN PADDOCK
Zip Code: 92662
Owner Address:
200 SAPPHIRE AVE
City:
NEWPORT BEACH
State: CA
Zip Code: 92662
Home Phone: 801-589-9490
Owner's Authorized Agent: YVEFTE CASAL'.
Work Phone: 714-520-1427 _.
Agent Address:
188 E. 17TH ST 3216
-. City:
COSTA MESA
State: F
Zip Code: 92627
Agent Email Address:
FRANCOYVETTE@GMAIL.COM
Escrow Company:
Escrow #: 169957 -PC
CENTRAL ESCROW GROUP INC
Escrow Address:
1015 S. BALDWIN
City:
RCADIA '..
State:
F
Zip Code:
91007...
Escrow Phone: 626-254-9977 ext 107
Email Report to:
FRANCOYVETTE@GMAIL. CCM
For Inspection call
(Name):
YVETTE CASAL
Direct Phone:
1714-520-1427
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 violation
Owner/Agent's signature to authorize inspection: 1 G
OR
Owner/Agent's signature to decline inspection:
3udding_Divis1on\F.,.s\RBR_7-3LL20
Date: I S/13/2021
Date:
Account # 01050504-521040 .................Make checks payable to: CITY OFNEWPORTBEACH