HomeMy WebLinkAboutR2020-0903 - Permit ApplicationDocuSign Envelope ID: 7F650C3D-2094-4497-AC 11-FAC1414631DF
Print Form City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 17681 Newport Beach, CA92658-8915
RBR# 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
# of Units: 7 Address: 18 ODYSSEY COURT #116 City: Newpo t Beach state: zip: 92663
Property Owner: TYLER DO KEEN Zip Code:92663
owner Address: 1 17197 Newhope Street Suite J City: rFountain Valley
State: CA Zip Code: 92708 Home Phone: 1 (949)527-1337
Owner's Authorized Agent: JEFF WEST Work Phone: 1 (714)307-6564
Agent Address: 4 Corporate Plaza Drive #100 City: F Newport Beach
State: FCA Zip Code F 92660. Agent Email Address: realwesthomes@gmail.com
Escrow Company: ADORE ESCROW INC. Escrow #: 20P53698 -JT
Escrow Address:) 14615 Magnolia Street
State: CA Zip Code: F 92683
City: Westminster
escrow Phone:) 714-892-0407
Email Report to:I jtran@adoreescrow.com
For Inspection call (Name): TYLER DO KEEN Direct Phone: (949)527-13T—
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
BocuSlgnIed by:
Owner/Agent's signatureto,decline inspedion:. �'rh�t,y t`tt,, Date:
�--A53AG55AMBME6_.
Account #.............. Make checks payable to: CITY OF NEWPORT BEACH
Building Division\Forms\RBR 7-30-20