HomeMy WebLinkAboutR2022-0085 - Permit ApplicationDocuSign Envelope ID: AOB676FE-8147-491A-8285-FCCDFB751960
Print Farm City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
VIM
Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
RBR# V I r�V -#Q �0 www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
Application Fees: Single Family Res/Condo (1 unit) - $165.00 Notice:
Duplex (2 Units) - $192.00 Application with insufficient fee payment
More than 2 units - $192.00.+ 11.00 per unit overt or incomplete will be returned
Reinspection Fee $88.00
Please type or print and complete all information
# of Units: Address: 500 Fernleaf Avenue City: Newport Beach State: CA Zip: 92625
Property Owner: Stephen B. Palmer, as Successor Trustee of the Palmer Family Trust dated February 2 1995
Zip Code:
Owner Address:
State: CA Zip Code:
City:
Home Phone:
Owner's Authorized Agent: Steve High Work Phone:
Agent Address: 450 Newport Center Drive, suite 100 City: Newport Beach
State:CA Zip Code: 92660 Agent Email Address: SHigh@Villarealestate.com
Escrow Company: Key Escrow, Inc.
Escrow # 006087 -BR
Escrow Address: 450 Newport Center Drive, 230 City: Newport Beach
State: CA Zip Code: 92660 Escrow Phone: (949) 698-1960
Email ReportTo: brandi@keyescrow.com
for Inspection Call (Name): 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
violations are discovered I will be responsible to correct said violations.
Owner/ Agent's signature to authorize inspection: Date:
Owner/ Agent's signature to decline inspection: Date:
Account #2900-5005........... Make checks payable to CITY OF NEWPORT BEACH