HomeMy WebLinkAboutR2020-0869 - Permit ApplicationDocuSign Envelope ID: 907EE63F-0418-49F7-A408-E38121F048B4
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'IhtIr' City of Newport Beach
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COMMUNITY DEVELOPMENT DEPARTMENT oEVEt a1'neEN'
BUILDING DIVISION
2010 _ Ulp� 100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA92K8TA1752O20
RBR# 0 www.newportbeachca.gov(949)644-3200
CI"rY OF
Application for Report of Residential Building Records
Application Fee: -.$194.00 Notice: PORFI
(For All Residential Buildings)r'. - Applications with insufficient fee payment
Reinspection Fee $129.00 - or incomplete will be returned
Please type or print and complete all information
#of Units: F Address: 2015 Commodore Rd. _City: NewportBeach State: CA ,.Zip: 92660
Property Owner: Scott Anthony Lanni , Trustee Zip Code: 92660
Owner Address: 2015 Commodore Rd. City: Newport Beach
State: CA.. Zip Code: 92660 Home Phone:
Owner's Authorized Agent: Tim Carr Work Phone: 949.631.9999
Agent Address: 450 Newport Center Dr., Ste. 100 City: New part Beach
State: FCA Zip Code: F92660 Agent Email Address: tci@timcarrgroup.com '..
Escrow Company: Mariners Escrow Escrow #: 59411 -BF
Escrow Address: 270 Newport Center Dr., Ste. 200 '', City: Newport Beach
State: CA Zip Code: F92660 Escrow Phone:
Email Report to:bfoxcroft@marinersescrow.com, tci@timcarrgroup.com
For Inspection call (Name): _., __.. __.. _., 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
q.
Owner/Agent'ssignaturetodecline inspection: �s -a.�a.,,�: Date:.10/6/2020 19:10 AM PDT
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
Buildin�Division\Forms\RBR 7-30-20