HomeMy WebLinkAboutR2020-0944 - Permit ApplicationCITY OF NEWPORT BEACH
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
www.newportbeachca gov 1 (949)644-3200
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RBR # CDmNtlNl7y
Application for Report of Residential Building Records NOV 05 RECD
Application Fee: $194.00 Notice:
Q DEVEIO
(For All Residential Buildings) Application with i&fficientp 9ffay&ent
Reinspection Fee $125.00 or incomplete will beCl%=urned SEP
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Please type or print and complete all information
Number of units:_ Street Address: 433 Acacia Ave
Property Owner: The Dahlberg Family Trust dated April 7, 1988
Owner Address: 51�6
Home Phone: q -( [ ` D 3 Gf J ( / Work Phone:
Owner's Authorized Agent: BRANDEN FELLA, COMPASS
Agent Address: 341 Bayside Drive , Newport Beach, CA 92660
Work Phone: 949 870-7913
Zip Code:
ki
D cr q 13 0
Zip
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Escrow Name and Address: West Coast Escrow, Escrow No. 4530320-10643 - LS
Escrow Address: 31582 S. Coast Highway, Laguna Beach 92651 Escrow Phone: (949) 499-4622
Email Report to: LAURA. STE INER@WESTCOASTESCROW. COM
For Inspection Call (Name): NA Phone: NA
CONSENT TO INSPECT (FORM MUST BE SIGNED AND DATED BELOW)
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/Agent's signature to authorize inspection Date
OR
Owner/Agent's signature to decline inspection Date
Account #01050504-521040............ Make checks payable to CITY OF NEWPORT BEACH
Who to call for inspection?