HomeMy WebLinkAboutR2021-0752 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT ;;i9IVE7 r
BUILDING DIVISION CONrNMNI Y
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8@,1,5 , n an_rrr
www.newportbeachca.gov 1 (949) 644-3200
RBRIVIU A410I _ OCT 2 2 2021
Application for Report of Residential Building RecordSITYOF
Application Fee: $198.00 Notice: Applications witK I�iSSffiGient fee
payment
Reinspection Fee $ 131.00 or incomplete will be returned
Please type or print and complete all information
# of Units:_1_ Address:36 Cape Andover City: Newport Beach State: CA Zip: 92660
Property Owner: Donald E. Cornforth and Edna L. Cornforth
Owner Address: - City:
State: -Zip Code: _ Home
Owner's Authorized Agent: Debi Bibb Work Phone:
Agent Address: 1200 Newport Center Drive, Suite 100, City: Newport Beach State: CA Zip Code: 92660
Mobil Phone: - Agent Email Address: dbibb@homarroup com
Escrow Company: Mariners Escrow Escrow # 176 67-BF
Escrow Address: 270 Newport Center Drive, Suite 200
State: CA Zip Code: 92660
Email Report To: bfoxcroft@marinersescrow.com
For Inspection Call (Name):
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
Owner or Agent's signature to decline inspection
Account # 2900-5005.................Make checks payable to CITY OF NEWPORT BEACH