HomeMy WebLinkAboutR2022-0084 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
l`q I�/)' �b/1/�,� 100 Civic Center Drive P.O. Box 1768 1 Newport Beach, CA 92658-8915
RBR# 1` W W U'(/ www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
Application Fee: - $198.00 Notice:
(For All Residentia l Buildings) Applications with insufficient fee payment
Reinspection Fee $131.00 or incomplete will be returned
Please type or print and complete all information
# of Units: LJ Address: L2542 Circle Drive -', City: Newport Beach State: CA ;Zip: 82663
Property Owner: MaransFamilyTrust Zip code: I
Owner Address: City:
State: CA Zip Code Home Phone:
Owner's Authorized Agent Work Phone:
Agent Address: City:
State: �) Zip Code: Agent Email Address:
Escrow Company: Freedom Escrow Escrow #: 055192 -MM
Escrow Address: 1200 Newport Center Dr., Suite 180 city:
Newport Beach
_.._
State:FF
Cq Zip Code 92660 Escrow Phone: (949) 644-3939
- -- —
Email Report to: mm@freedomescrow.com -
For Inspection call (Name): N/A -. J Direct Phone:—�
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
I authorize inspections and re -inspections of the, property listed above.' I understand that ifBuilding '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: /, _ SY Date:
Account # 01050504-521040 ................. Make checks payable to: CITY OF NEWPORT BEACH
BuildinRDivisinn\Farms\RBR 7-1-31