HomeMy WebLinkAboutR2022-0200 - Permit Application�,�cElv�a DocuSign Envelope ID: F6342F6D-OF29-4FF8-BD99-7043E7ADBA3F COMMUNITeY)
DEVELOPMENT
APR 1 z 2022
Print Form City of Newport Beach CITY OF
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION"upT, BPG�`
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
RBR# www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
Application Fees: Single Family Res/Condo (lunil)-$198.00 Notice:
Application with insufficient fee payment
or incomDlete will be returned
Please type or print and complete all information
# of Units: Address: 11 Harbor Island City: Newport Beach State: CA Zip: 92660
Property Owner: Curtis Olson
Owner Address:
State:
Zip Code:
City:
Home Phone:
Zip Code:
Owner's Authorized Agent: AJ.Olson Whitfield Work Phone: (949)433-8989
Agent Address: 450 Newport Center Drive, suite 100 City: Newport Beach
State:CA Zip Code: 92660 Agent Email Address: AWhitfield@VillaRealEstate.com
Escrow Company: Key Escrow, Inc. Escrow #
Escrow Address: 450 Newport Center Drive, 230 City: Newport Beach
State: CA Zip Code: 92660 Escrow Phone: (949)698-1960
Email Report To: brandi@keyescrow.com
for Inspection Call (Name): Direct
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED
I authorize inspections and re -inspections of the property listed above. I understand that if Building or Zoning
violations are discovered I will be responsi f1g8p1
estC11' 4�tKs.
Owner/ Agent's signature to authorize inspection, ._ �I,,JJdv Date:
LINED
4/11/2022
Owner/ Agent's signature to decline inspection: dv-�u Date:
Account #2900-5005........... Make checks payable to CITY OF NEWPORT BEACH