HomeMy WebLinkAboutR2022-0313 - Permits (2)Print Form
City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
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COMMUNITY
DEVELOPMENT
JUN 3 0 2022
BUILDING DIVISION CITY OF
2 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
RBR#' "✓ www.newportbeachca.gov 1 (949) 644-3200 "4PORT aEpc"�,
Application for Report of Residential Building Records
Application Fee:-$194.00 Notice:
(For All Residential Buildings) Applications with Insufficient fee payment
Rein spection Fee $129.00 or incomplete will be returned
Please type
or print and complete all information
# of Units:. Address:..
City: = Newport Beach Stater
[.Zip;
F92660
10 Saint Laurent
Property Owner: Christopher & Halleigh Hill Zip Code: F 92657
Owner Address: 10 Saint Laurent City: FNewport Coast
State: CA Zip Code: F92657 Home Phone:
Owner's Authorized Agent: Jacqueline Thompson (Surterre Properties) work Phone: 49-717-7100
Agent Address: 1400 Newport Center Dr. #100 City: I Newport Beach
State: CA Zip Code: 92660 Agent Email Address: jacqueline.h.thompson@gmail.com
Escrow Company: I Blue water Escrow, Inc,.
Escrow Address:I 1400 Newport Center Dr. #125
State: F CA Zip Code: F9
2e60
Email Report to: I jason®bluewaterescrow.com
For Inspection call (Name): N/A
Escrow #: 22-8046-JM
City: Newport Beach
Escrow Phone: 1 949-479-7900
Direct Phone: I
CONSENTTO 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. p��+t-pr�+ n'
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Owner/Agent's signature to authorize inspection: n,*p.
DECLINE
Owner/Agent's signature to decline inspection: /—_Date:
Account # 01050504-524040 - ...............Make checks payable to: CITY OF NEWPORT BEACH
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