HomeMy WebLinkAboutR2020-0284 - Permit ApplicationCity of Newport Beach RIVED
COMMUNITY DEVELOPMENT DEPARTMENT �' br
BUILDING DIVISION COMMUNITY
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-86 6LOPMENi
www.newportbeachca.gov 1 (949) 644-3200 MAR 12 2O2O
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Application for Report of Residential Building Records r' OF
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Application Fee: $191.00 Notice: Applications with insufficient fee
payment
or incomplete will be returned
Please type or print and complete all information
# of Units:_ Address: 919 East Balboa Blvd. City: Newport Beach State: CA Zip: 92661
Property Owner: Groundswell Investments, LLC
Owner Address: - City:
State: -Zip Code:- Home
Owner's Authorized Agent: Art White Work Phone:
Agent Address: 700 E. Balboa Blvd, City: Newport Beach State: CA Zip Code: 92661
Mobil Phone: (949) 673-9900
Escrow Company: Mariners Escrow
Agent Email Address:
Escrow Address: 270 Newport Center Drive, Suite 200
State: CA Zip Code: 92660
Email Report To: bfoxcroft@marinersescrow.com
For Inspection Call (Name):
Escrow # 57943 -BF
City: Newport Beach
Escrow Phone: 949-640-6040
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
Direct Phone:
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 d(� ' ,JS
OR ,U vT�`
4Owner or Agent's signature to decline inspection3ffCr Date: 3 12_20)
Account # 2900-5005 ................. Make checks payable to CITY OF NEWPORT BEACH