HomeMy WebLinkAboutR2022-0076 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
Ian oL�s�� fa 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
ld www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
Please type or print and complete all information
# of Units: o Address: 38 Rockingham Drive _ City: i Newport Beach State: CA IZip:55F7771
Property Owner: The Kramer Survivor's Trust Zip Code:
Owner Address: City:
State: CA Zip Code: Home Phone:F 71
Owner's Authorized Agent: 'I Work Phone:
Agent Address: City: j
State: �, Zip Code: I� Agent Email Address:
Escrow Company: Freedom Escrow Escrow #: 055186 -MM
Escrow Address: 11200 Newport Center Dr., Suite 180 City: I Newport Beach
State: Cq Zip Code: LWMK Escrow Phone:(949) 644-3939
Email Report to: mm@freedOmeSCfOW.COm
For Inspection call (Name): N/A Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
1 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: bate:
OR
Owner/Agent'ssi naturetodeclineins ecton: Date:
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Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
Building Division\F.,.s\RBR_7-1-21