HomeMy WebLinkAboutR2022-0002 - Permit ApplicationRBR#
City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
Application Fee: $198.00 Notice: Applications with insufficient fee
payment
Reinspection Fee $ 131-00 or incomplete will be returned
Please type or print and complete all information
# of Units:_ Address:3631 Ocean Boulevard City: Corona Del Mar State: CA Zip: 92625
Property Owner: Douglas W Jackson Family Trust dated September 30 1987.
Owner Address: 3631 Ocean Boulevard City: Corona Del Mar
State: CA Zip Code: 92625 Home
Owner's Authorized Agent: Rob Giem Work Phone:
Agent Address: 520 Newport Center Dr. Ste 330, City: Newport Beach State: CA Zip Code: 92660
Mobil Phone: 949-933-7046 Agent Email Address: roUlirolaciern.com
Escrow Company: Mariners Escrow
Escrow Address: 270 Newport Center Drive Suite 200
State: CA Zip Code: 92660
Email Report To: pkennedy@marinersescrow.com
For Inspection Call (Name):
Escrow # 62090 -PK
City: Newport Beach
Escrow Phone: 949-640-6040
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 if Building or Zoning
violations are discovered I will be responsible to correct said violations.
Owner or Agent's signature to authorize inspection
OR
Owner or Agent's signature to decline inspectio Date:
Account # 2900-5005 ................. Make checks payable to CITY OF NEWPORT BEACH