HomeMy WebLinkAboutR2021-0840 - Permit ApplicationPrint Farm
City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
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(I o28 A g2 l 100 Civic Center Drive I P.O. Box 17681 Newport Beach, CA 92658-8915
RBR# /� l 0 V www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
Application Fee: - $198.00 Notice:
(For All Residential Buildings) Applications with insufficient fee payment
Reinspection Fee $131.00 or Incomplete will be returned
Please type or print and complete all information
#of Units: F Address: 326 Holmwood Drive City: Newport Beach State: CA Zip: 92663
Property Owner. Laz Living Trust Zip Code: 92663
Owner Address: 326 Holmwood Drive City: Newport Beach
State: IC' — Zip Code: 92663 Home Phone:
Owner's Authorized Agent: I Coleen Brennan
Agent Address: I 3636 E. coast Hwy.
State: CA Zip Code:92625
Work Phone: 1 949-275.2776
City: I Corona del Mar
Agent Email Address: I eelesn.brennan@evrealeslate.ccm
Escrow Company: Gestalt croup Escrow, Inc Escrow #: 1634 -ow
Escrow Address: 1263 Argonne Ave., 9D,
State: ceilfornia Zip Code: Fgo803
Email Report to: I cindyw@gestaligmupescmw.com
For Inspection call (Name): I wA
City: I Long Beach
Escrow Phone: 1 714461-3339
Direct Phone: wA
CONSENTTO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
I authorize inspections and re -inspections of the property listed above. I understand that if Building orZoning
violations are discovered I will be responsibleto correct said violations.
Owner/Agent's signature to authorize inspection: NIA Date: INIA
Owner/Agent's signature to decline inspection:
Bwlding-DNBRIntF..ARaRJ-Yll
OR
x Date:
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH