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HomeMy WebLinkAboutR2021-0413 - Permit ApplicationDocuSign Envelope ID: BE6254DC-7780-4291-8F50-28DBC48CA24F Print FArn% City of Newport Beach COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION q on �j i 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915 RBR# '(/ G "j' 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 Property Owner] Brad and Heather.. Maddock. Owner Address ..1380 Galaxy Drive State: CA Zip Code 92660 Zip Code:92660 City: Newport Beach Home Phone: 949-929-4499 Owner's Authorized Agent: Westley Williams Work Phone 949-290-7995 Agent Address: 190 Newport Center Dr#290 City: Newport Beach State: CA Zip Code 92660 Agent Email Address`. westley@westleywilliams.com Escrow Company: Taylor Escrow Escrow #: 21 -7086 -DD Escrow Address: 3 Monarch Bay Plaza #104 City: Dana Point State. FCA Zip Code: 92629 Escrow Phone. 949-380-8589 Email Report to: Deidre@taylorescrow.com For Inspection call (Name): Direct Phone: CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW) I authorize inspectionsand re -inspections of the property listed above. I understand that if Building or Zoning violations are discovered l will be responsible to correct said violations. Owner/Agent's signature to authorize inspection: Date: DocuSigned by R Owner/Agent's signature to decline inspection:���, Date: 5/25/2021 —75+zooe3oc ... Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH Bulltling Division\Forms\RBR ]-30-20 Please type or print and complete all information # of Units: I " Address 1380 Galaxy Drive. City Newport Beach State [CA .,,Zip 92660 Property Owner] Brad and Heather.. Maddock. Owner Address ..1380 Galaxy Drive State: CA Zip Code 92660 Zip Code:92660 City: Newport Beach Home Phone: 949-929-4499 Owner's Authorized Agent: Westley Williams Work Phone 949-290-7995 Agent Address: 190 Newport Center Dr#290 City: Newport Beach State: CA Zip Code 92660 Agent Email Address`. westley@westleywilliams.com Escrow Company: Taylor Escrow Escrow #: 21 -7086 -DD Escrow Address: 3 Monarch Bay Plaza #104 City: Dana Point State. FCA Zip Code: 92629 Escrow Phone. 949-380-8589 Email Report to: Deidre@taylorescrow.com For Inspection call (Name): Direct Phone: CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW) I authorize inspectionsand re -inspections of the property listed above. I understand that if Building or Zoning violations are discovered l will be responsible to correct said violations. Owner/Agent's signature to authorize inspection: Date: DocuSigned by R Owner/Agent's signature to decline inspection:���, Date: 5/25/2021 —75+zooe3oc ... Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH Bulltling Division\Forms\RBR ]-30-20