HomeMy WebLinkAboutR2023-0631 - Permit ApplicationRECEIVED By
Drint Form City of Newport Beach COMMUNITY
COMMUNITY DEVELOPMENT DEPARTMENT DEVELOPMENT
BUILDING DIVISION JUL 14 2023
100 Civic Center Drive I P.O. Box 1768 I Newport Beach, CA92658-8915
RBR# 12Zo23 Eafo31 www.newportbeachca.gov I (949) 644-3200 CITY OF
NEWPORT13EACH
Application for Report of Residential Building Records
Application Fee: - $202.00 Notice:
(For AIIResidential 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: 515 Orange Avenue City: Newport Beach State: CA Zip: 92663
Propertyowner: James Madden Zip Code: F
Owner Address: City
State: CA Zip Code: F Home Phone:
Owner's Authorized Agent: I Work Phone:
Agent Address: City:
State: r Zip Code: F Agent Email Address:
Escrow Company: I Freedom Escrow
Escrow Address: 11200 Newport Center Dr., Suite 180
State: FCA Zip code: 92660
Email Report to: mm@freedomescrow.com
For Inspection call (Name): I N/A
Escrow #:1055905-MM
City: I Newport Beach
Escrow Phone: I (949) 644-3939
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 responsible to correct said violations.
Owner/Agent's signature to authorize inspection: Date:
OR
Owner/Agent's signature to decline a7.%3-2-S
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
Budding_Division\Forms\RRR 6-15-22