HomeMy WebLinkAboutR2021-0804 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 9265878915
��qf���j QI1I www.newportbeachca.gov 1 (949) 644-3200 -
RBR# 1 a"�I �VV Kiv t, u ru4
Application for Report of Residential Building Records
0 i Y
Application Fee: $198.00 Notice: Applications with insufficient fee
payment
Reinspection Fee $ 131.00 or incomplete will be returned
Please type or print and complete all information
# of Units:_ Address:1516 Bruinbark Lane City: Newport Beach State: CA Zip: 92660
Property Owner: Rachel Rina White
Owner Address: 1516 Bruinbark Lane City: Newport Beach
State: CA Zip Code: 92660 Home Phone: 818-645-8316
Owner's Authorized Agent: Annie Clougherty Work Phone:
Agent Address: 341 Bayside Drive. City: Newport Beach State: CA Zip Code: 92660
Mobil Phone: (949) 375-3037 Agent Email Address: annie.clougherty@compass.com
Escrow Company: Mariners Escrow
Escrow Address: 270 Newport Center Drive, Suite 200
State: CA Zip Code: 92660
Email Report To: swelker@marinersescrow.com
For Inspection Call (Name):
Escrow # 61947 -SW
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
�
OR
j�
Owner or Agent's signature to decline inspection lS "tet--- Date:
Account # 2900-5005 ................. Make checks payable to CITY OF NEWPORT BEACH