HomeMy WebLinkAboutR2020-0554 - Permit ApplicationDocuSign Envelope ID: C43094B3-8041-4EFC-AIDF-748EC20FFC9D
Print Form City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
Q vic Center Drive I P.O. Box 1768 Newport Beach, CA 92658-8915
RBR Vt/ www.newportbeachca.gov (949)644-3200
Application for Report of Residential Building Records
Application Fees: Single Family Res/Condo (lunit) -$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: 2144 East Ocean Front City: Newport Beach State: CA Zip: 92661
Property Owner: 2144 Ocean, LLC Zip Code:
Owner Address: City:
State: CA Zip Code: Home Phone:
Owner's Authorized Agent: Devin Lucas 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 # 004643 -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.
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: I Date:
7/1/2020
Account #2900-5005... ........ Make checks payable to CITY OF NEWPORT BEACH
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