HomeMy WebLinkAboutR2022-0065 - Permit Applicationrn? City of Newport Beach IQ,c
COMMUNITY DEVELOPMENT DEPARTMENT COMMUNITY
DEVELOPMENT
BUILDING DIVISION
fn�100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92P§§-490!k0Z2
www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Record'sI'TY OF
Application Fee: - $198.00Notice• ' PORT'a
(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:n Address: 21 Jasmine Creek Drive City New ort Beach State; nZip; 92625
P
Owner's Authorized Agent:
Terry Reay
Work Phone:
1 (714) 322-4088
Agent Address:
19671 Beach Blvd. #100
qty:
Huntington Beach
State:
CA
Tip Code:
92648 j
Agent Email Address:
terryreay@sevengablea.com
Escrow Company: I Advantage one Ewt Escrow #: 271124 -TS
Escrow Address:19671 Beach and
#103 I City: Huntington Beach
State: CA Ttp Code: 92648 Escrow Phone: 714-062-0999
Email Report to:
6na@advantagwneewc .com: terryreay@sevengables.com
For Inspection call (Name): Terry Reay I Direct Phone: (714 322-4060
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 l will be responsible to correct said violations.
Owner/Agent's signature to authorize inspection:
Date: �—
OR
Owner/Agent's signature to decline inspection: Date. �L
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
BuildI Division\Forms\RBF 7.1.21