HomeMy WebLinkAboutR2023-0180 - Permit ApplicationRECEIVED By
COMMUNITY
City of Newport Beach DEVELOPMENT
COMMUNITY DEVELOPMENT DEPARTMENT MAR 0 6 2023
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-M5)F
BR# RP-3vZ31 " a1sN
O www.newportbeachce.gov 1 (949) 644-3200 EWPOWBEACH
Application for Report of Residential Building Records
Application Fee: - $202.00 Notice:
(For All Residential Buildings) Applications with insufficient fee payment
Reinspection Fee $134.00 or incomplete will be returned
Please type or print and complete all information
It of Units: 1 ! Address: 12 Sand Dollar Court Unit 6 City: Newport Beach j State: F Zip: 92663
-
Propertyowner: Patrick William Healy
Owner Address: _ City:
State: CA -'', Zip Code: F Home Phone:
Owner's Authorized Agent:
Agent Address:
Zip Code: --- 77
Work Phone:
City: ------------- -
State: F—'', Zip Code: Agent Email Address:
Escrow Company: Freedom Escrow Escrow#: 055724-MM j
Escrow Address: 1200 Newport Center Dr., Suite 180 City: Newport Beach
— _-.I
State: CA Zip Code: 92660 Escrow Phone: (949) 644-3939
Email Report to: mm@freedomeSCfOW.COm
For Inspection call (Name): N/Q Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOWI
l authorize inspections and re -inspections of the property listed above. I understand that if Building or Zoning
violations arediscovered I will be responsible to correct said violations.
Owner/Agent's signature to authorize inspection: Dater
OR
Owner/Agent'ssignatureto decline, �f£r�..�r g-�Aa2NrDate: Q(rC,'z3-....�
Account # 01050504-521040.................Make checks payable to: CITY OF NEWPORT BEACH
Building Division\Farms\RBR 6-15-22