HomeMy WebLinkAboutR2021-0468 - Permit ApplicationDocuSigg.E eloPe ID: 174BBD12-AE7A-403C-8B85-2EA1 B78AB669
tar L: EtVSfO
hF_' EMMUMITy�
ION�L11=Arr
Print Form City of Newport Beach JAN 2 4 ZQ21
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA 92658-8915'I'Ty OT
RBR# u "'��� www.newpodbeachca.gov (949)644-3200
Application for Report of Residential Building Records �o r BEPCta
Application Fees: Single Family Res/Condo (1 unit) - $165.00
Notice:
Duplex (2 Units) - $192.00
Application with insufficient fee payment
More than 2 units - $192.00 + 11.00 per unit over 2
or incomplete will be returned
Reinspection Fee $88.00
Please type or print and complete
all information
# of Units: Address: 319 Grand Canal
City: Newport Beach State: CA Zip: 92662
Property Owner: Daniel J. Gannon and Tammy Gannon
Zip Code:
Owner Address:
City:
State: CA Zip Code:
Home Phone:
Owner's Authorized Agent: Steve High
Work Phone: (949) 717-6000
Agent Address: 450 Newport Center Dr., Ste. 100
City: Newport Beach
State:CA Zip Code: 92660 Agent Email Address:
Escrow Company: Key Escrow, Inc. Escrow # 005660 -BR
Escrow Address: 450 Newport Center Drive, 230 City: Newport Beach
State: CA Zip Code: 92660 Escrow Phone: (949)698-1960
Email Report To: corina@keyescrow.com
for Inspection Call (Name):
Direct
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
violations are discovered I will be responsible to correct said violations.
Owner/ Agent's signature to authorize inspection:
Date:
that if Building or
vo<sm+<a vy:
Owner/ Agent's signature to decline inspection: � ${wi, (kir, Date: 6/24/2021
�a
Account #2900-5005........... Make checks payable to CITY OF NEWPORT BEACH