HomeMy WebLinkAboutR2021-0197 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
www.newportbeachca.gov 1 (949) 644-3200
RBR# V2021-01°1'
Application for Report of Residential Building Records
Application Fee: $194.00 Notice: Applications with insufficient fee
payment
Reinspection Fee $ 129.00 or incomplete will be returned
Please type or print and complete all information
# of Units: Address:615 1/2 Begonia Avenue City: Newport Beach ( Corona Del Mar Area ) State: CA
Zip: 92625
Property Owner: Coastlands LLC a South Carolina limited liability company
Owner Address: - City:
State: _Zip Code:- Home Phone:
Owner's Authorized Agent: John Yasko/ Tim Smith Work Phone:
Agent Address: 840 Newport Center Dr. #100, City: Newport Beach State: CA Zip Code: 92660
Mobil Phone: (949) 207-8063 Agent Email Address: 0ohn0timsmithgrour).com
Escrow Company: Mariners Escrow
Escrow Address: 270 Newport Center Drive, Suite 200
State: CA Zip Code: 92660
Email Report To: djohnson@marinersescrow.com
For Inspection Call (Name):
Escrow # 60304 -DJ
City: Newport Beach
Escrow Phone: 949-640-6040
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 or Agent's signature to authorize inspection Date: n 1
R �� I � I
Owner or Agent's signature to decline inspection 4 Date:
Account # 2900-5005 ................. Make checks payable to CITY OF NEWPORT BEACH