HomeMy WebLinkAboutR2021-0495 - Permit Application1
CITY OF NEWPORT BEACH
COMMUNITY DEVELOPMENT DEPARTMENT �&cEtVED ey
BUILDING DIVISION COMMUNITY
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-NT�50pMFNT
n (F www.newportbeachca.gov 1 (949)644-3200 JUL 0 9 2021
RBR# � G�Z�. U�
CITY OF
Application for Report of Residential Building Records *VPORT
Application Fee: $194.00 Notice:
(For All Residential Buildings) Application with insufficient fee payment
Reinspection Fee $125.00 or incomplete will be returned
Please type or print and complete all information
Number of units: 2 Street Address: 316 Grand Canal
Property Owner: Eric Prendergast and Nikki Minton NK
L 1 7 Zip Cade:
Owner Address: TRW Y-iow , toso, Y1�yU{I�L6(�pVLYj(AN I`�,
Street Citv j 7
Home Phone: I (ll� �CJ�-i�l.�/ Work Phone:
11
1266 2
Owner's Authorized Agent: GEORGIE FENTON, COLDWELL BANKER REALTY
Agent Address: 222 MARINE AVE #A, Newport Beach, CA 92662
Work Phone:
Escrow Name and Address: West Coast Escrow, Escrow No. 4530621-06226 - LS
Escrow Address: 840 Newport Center Drive, Suite 150 , Newport Beach 92660, Escrow Phone: (949) 759-7072
Email Report to: TRGWCENewportBeach@trgc.com
For Inspection Call (Name): Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED AND 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. JIMLn�t +.�/1 Date - I it
Account #01050504-521040............ Make checks payable to CITY OF NEWPORT BEACH
Who to call for inspection?
Name: Direct Phone: