HomeMy WebLinkAboutR2023-0695 - Permit ApplicationRECEIVED BY
Print Form City of Newport Beach COMMUNITY
COMMUNITY DEVELOPMENT DEPARTMENT DEVELOPMENT
BUILDING DIVISION JUL 27.
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
RBR# IR��✓' a�as www.newportbeachr-a.gov 1 (949) 644-3200 CITY OF
NEWPORT REACT;
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
# of Units: I-1 Address: 1320 Santa Ana Avenue City: Newport Beach State: CA Zip: F92663
Propertyowner:I Stekol Family Trust
Owner Address: City:
State: CA Zip Code:
Owner's Authorized Agent:
Agent Address: City:
State: F— Zip Code: F Agent Email Address:
Home Phone:
Work Phone:
Zip Code: F
Escrow Company: I Freedom Escrow Escrow #:1055927-MM
Escrow Address: 1200 Newport Center Dr., Suite 180 City: FNewport Beach
State: CA Zip Code: F92660
Escrow Phone: 1 (949) 644-3939
Email Report to: I 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 responsible to correct said violations.
Owner/Agent's signature to authorize inspection: Date:
OR
Owner/Agent's signature to decline fGl� 'AAd yA _ Date: p7.27.7—j
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
Building—Division\Forms\RBR_6-15-22