HomeMy WebLinkAboutR2020-0487 - Permit ApplicationDocuSign Envelope ID: 66DODFCF-025F-4245-B51C-F4F365C39EE7
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Print Form City of Newport Beach � OFA ylC4
- COMMUNITY DEVELOPMENT DEPARTMENT FSO
BUILDING DIVISION O'c p11%*
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8
RBR# % www.newportbeachca.gov 1 (949) 644-3200 PORT BFNG\
(/ 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 over 2
or incomplete will be returned
Reinspection Fee $88.00
Please type or print and complete all information
# of Units: Address: 2338 Tustin Avenue _
City: Newport Beach State: CA Zip:
Property Owner: Douglas O. Foster Revocable Trust
Zip Code:
Owner Address:
City:
State: CA Zip Code:
Home Phone:
Owner's Authorized Agent: Bill Lupis __
Work Phone: (949) 717-6000
Agent Address: 450 Newport Center Dr., Ste. 100
City: Newport Beach
State:CA Zip Code: 92660 Agent Email Address:
Escrow Company: Key Escrow, Inc.
Escrow # 004632 -BR
Escrow Address: 450 Newport Center Drive, 230
City: Newport Beach
State: CA Zip Code: 92660
Escrow Phone: (949) 698-1960
Email Report To: 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.
Agent's signature to authorize inspection: Date:
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Agent's signature to decline inspection.:__-9L.w,,.6u�SfG Date:
6/22/2020
Account #2900-5005........... Make checks payable to CITY OF NEWPORT BEACH