HomeMy WebLinkAboutR2022-0249 - Permit ApplicationV,ScEIVEI)By
COMMUNITY
-..�.e: DEVELOPMENT
City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT MAY 1:8 2022
BUILDING DIVISION
^� �( 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-WI,
RBR# �Z(l2Z y/ ZHq www.newportbeachca.gov 1 (949) 644-3200
��pORT BEPG�
Application for Report of Residential Building Records
.Auolication Fee. =.$198 00 . Notice::'
(For All Residential`Bwlclings)
; Applications with insufficient fee payment
ReinspectioW Fee $131.00 or incomplete willbe'returnetl
Please type or print and complete all information
State: Ca Zip Code: F92660 Agent Email Address: ljlynn@villareAlestate.com
Escrow Company: _.CeAtral.. BSCLow......Group,._ Inc. _ Escrow #: CEG3049257EL
Escrow Address: 22632 Golden Springs Dr._ Ste. 300 City' __IIiamand Bar.
State: Ca Zip Code: 91765 Escrow Phone: 909-860-5140
Email Report to elaounit@centralescrowgrotip.com__
For Inspection call (Name): Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
I authorize inspections and Fe -inspections of the property listed above. I understand that if Building or Zoning
violations are discovered I will be responsible to correct said violations.
Owner/Agents signature to authorize inspection: Date:—'.
INSPECTION OR
Owner/Agents signature to declineDiUNEI$ , Date: 6V6t 2-7,
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
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