HomeMy WebLinkAboutR2023-0583 - Permit ApplicationRECEIVED By
Print For City of Newport Beach COMMUNITY
COMMUNITY DEVELOPMENT DEPARTMENT DEVELOPMENT
BUILDING DIVISION f
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-(915
RBR# '(12923- - 0�7Fi3 www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
JUN 2 6 2023
CITY OF
NEWPORT BEACH
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
# of Units: Address: 1 512 Laver City: Newport Beach State: CA Zip: g2660
Propertyowner: Daniel C. Haight
Owner Address: City:
State: I" Zip Code: F—
Owner's Authorized Agent:
Agent Address:
State:
Zip Code:
City:
Agent Email Address:
Home Phone:
Work Phone:
Zip Code: F—
Escrow Company: Freedom Escrow Escrow#: 555848-MM
EscrowAddress: 1200 Newport Center Dr., Suite 180 city: I Newport Beach
State: CA Zip Code:F 92660 Escrow Phone: 1 (949) 644-3939
Email Report to: mm@freedomescrow.com
For Inspection call (Name): I N/A
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 I will be responsibleto correct said violations.
Owner/Agent's signatu re to authorize inspection: Date:
OR
owner/Agent'ssignatureto decline 7r�_ Date: 06/22/2023
Account # 01050504-521040.................Make checks payable to: CITY OFNEWPORT BEACH
Building DMsim\Farms\RBR_6-1522