HomeMy WebLinkAboutR2022-0392 - Permits-10VED @y
F City of Newport Beach COMMUNITY
COMMUNITY DEVELOPMENT DEPARTMENT DEVELOPMENT
BUILDING DIVISION I��II 99,,
t� �,y 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658�SJ15 Zn22
RBR# I-72?—C/3.2 www.newportbeachca.gov 1 (949) 644-3200
CITY OF
Application for Report of Residential Building Records�i,, __ aGP°N
Please type or print and complete all information
# of Units: Address: 601 Marguerite Avenue City: Newport Beach State: CA ;Zip: 92625
Property owner: Howard Dachslager Zip Code: F7771
Owner Address: City:
State: CA Zip Code: F— Home Phone:
Owner's Authorized Agent: Work Phone:
Agent Address: City:
State F Zip Code: Agent Email Address:
Escrow Company: Freedom Escrow Escrow #: 055468-MM
Escrow Address: 1200 Newport Center Dr., Suite 180 city: Newport Beach
State: t;q zip Code: g266 Escrow Phone: (949) 644-3939
Email Report to: mm@freedomescrow.com
For Inspection call (Name): jy/q 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 [will be responsible to correct said violations.
Owner/Agent's signature to authorize inspection: INSPECTION Date:
OR DECLINED
Owner/Agent's signature to decline Date:
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Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
Building Division\Forms\RBR_6-15-22