HomeMy WebLinkAboutR2022-0006 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
�Q" �j J62��' (� www.newportbeachca.gov 1 (949) 644-3200
RBR# 1 "0O1J
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: -l— Address: 435.5 Fernleaf Ave City: Newport Beach State: CA Zip: 92625
Property Owner: The 2000 JNS Trust, Under Declaration of Trust. Dated February 4 2000
Owner Address: _ City:
State: -Zip Code: _ Home
Owner's Authorized Agent: Laurie Eastman Work Phone:
Agent Address: , City: Newport Beach State: CA Zip Code: 92660
Mobil Phone: _ Agent Email Address:
Escrow Company: Mariners Escrow
Escrow Address: 270 Newport Center Drive, Suite 200
State: CA Zip Code: 92660
Email Report To: bfoxcroft@marinersescrow.com
For Inspection Call (Name):
Escrow # 62052 -BF
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
W
Owner or Agent's signature to decline inspection
Account # 2900-5005 ................. Make checks payable to CITY OF NEWPORT BEACH