HomeMy WebLinkAboutR2022-0097 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
W �2-6c� 100 Civic Center Drive P.O. Box 1768 1 Newport Beach, CA 92658-8915
RBR# 0q www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
AbplicationFee:-$198.00"Notice: "
(For All Residential Buildings), "'
B I ", ;'I Applicati.ons with insufficient fee payment
Reinspection Fee $131.00 or incomplete will be returned
Please tVpe or print and complete all information
It of Units: Address: 423 62nd Street's City: Newport Beach 1 State: CAlzip:F 92660
Propertyowner: The Ronald A. Crowe Family Trus(777777
Owner Address: City:
----.......— - ----- __.-.........--- ------
State: F7-71 Zip Code �,, Home Phone:
Owner's Authorized Agent: — - _ _ j Work Phone:
Agent Address: City:
State: Zip Code: Agent Email Address:
Zip Code: F7---71
Escrow company: Freedom Escrow Escrow #: 055200 -MM
Escrow Address:12I 00 Newport Center Dr., Suite 180 1 city: I Newport Beach
State: F CA Zip Code: 92660 Escrow Phone: 1 (949) 644-3939
Email Report to: mm( freedomescrow.com
For Inspection call (Name): N/A Direct Phone: l
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOWI
I authorize inspections and re'inspections ofthe 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 inspection:M+.C`..4+ g,y r Date: p2,2S ZZ i'
Account # 01050504-521040 .................Make checks payable to: CITYOFNEWPOFT BEACH
Building DM Ion\Fnrms\ABR_]-1-z1