HomeMy WebLinkAboutR2022-0010 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
y�BUILDING DIVISION
X2022 ��Q� D 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
RBR# www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
Application Fee: - $198.00 Notice:
,(For AIIResidential Buildings) Applications with insufficient fee payment
Reinspection Fee $ 131.00 or incomplete will 6e returned
Please type or print and complete all information
# of Units: Address: 114 East Oceanfront City: Newport Beach State: FCA 92661
Property owner: Hall Family Trust Zip code: F
Owner Address: City:
State: FCA777__ Zip Code: Home Phone:
i
Owner's Authorized Agent: Work Phone: '.....
Agent Address: City:
State: Zip Code: Agent Email Address:
Escrow Company:Freedom Escrow Escrow #: 055117 -MM
Escrow address: 1200 Newport Center Dr., Suite 180 city: Newport Beach
state:Zip Code: 92660 Escrow Phone: (949) 644-3939
Cq_
Email Reportto: mm@freedomescrow.com
For Inspection call (Name): N/A _ 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 l will be responsible to correct said violations
Owner/Agent's signature to authorize inspection: Dater
OR
Owner/Agent's signature todecline inspection:
13y,46E�VF Date:
Account # 01050504-521040 ................. Make checks payable to: CITY OF NEWPORT BEACH
BuildinR_oivision\Forms\RBR I-1-21