HomeMy WebLinkAboutR2020-0948 - Permit ApplicationCity of Newport Beach �,gCEIVEO ey
COMMUNITY DEVELOPMENT DEPARTMENT COMMUNITY
BUILDING DIVISION DEVELOPMENT
100 Civic Center Drive I P.O. Box 17681 Newport Beach, CA92650MP#6 Z�ZO
RBR# D l "' www.newportbeachca.gov (949) 644-3200
Application for Report of Residential Building
Please type or print and complete all information
# of Units: FT Address 900 E. OCearlffOnt City: Newport Beach State: CA -,Zip: 82661
Property Owner: Groundswell Investments, LLC Zip Code:
Owner Address: City:
State: CA Zip Code �I Home Phone:
Owner's Authorized Agent: Work Phone:
Agent Address: '': City:
State. _J Zip Code:
Agent Email Address:
Escrow Company: LFreedorn Escrow Escrow #: 054159 -MM
— — J
Escrow Address: 1200 Newport Center Dr., Suite 180 City: Newport Beach j
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State: CA — J Zip Code: 92660 Escrow Phone: 1 (949) 644-3939
EmailReportto: mm@freedomescrow.com
For Inspection call (Name): NA Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
I authorize inspections and re-inspectionsof the propertylisted 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
i
Owner/Agent's signature to decline inspection: 09,AG—rh?7—
Date:
t/
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
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