HomeMy WebLinkAboutR2020-0882 - Permit ApplicationDccuSign Envelope ID: C9AC83A1-60E8-43EE-A29D-5C1C1832E60B
Print Form City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
A _ .�?�7�C' v 'to'Drive I P_0Box 17681 Newport 1: mch, CA 92658-8915
313- __....... �(� +,ti+,netropndne ,Gtcagov: (949"6443200
Application for Report of Residential Building Records
,eppacmion tees; ample rarruy nes!i,,onao ttaniy-.tto,�.uu Nouce::
-. ................
Duplex (2 Units)- S192.00 A.5pli:ration wltn insufficient fee payment
More than 2 units -.5192.00 t 11.00 per unit ever 2 or incomplete will he returned
Reinspection Pee $88.00
Please type or. print and complete all information
# of Units: Address 20.Odyssey Court #114 City: Newport Beach State CA Zip 92663
Property Owner: Jeff re�r G. Heimstaedt and Diane .L Heimstaedt Zip
Owner Address: _ City
State: CA
Zip Code:
Owner's Authorized Agent: FSBO
Home Phone:
Work Phone:
Agent Address ............ ._, -__ City.
State:CA Zip Code: Agent Email
Escrow Company; Key Escrow, Inc.
Escrow Address: 450 Newport Center Drive, 230
State: CA Zip Code:
Email Report To: brandl@keyescrow.com
for Inspection Cali (.Name)
Direct
Escrow # 004877 -BR
City Newport Beach
Phone: (949;63B-1360
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
I authorize inspections and re -inspections of the property I'..sted above. I Understand that if Building or Zoning
violations are discovered I will be responsible to correct, said violations.
Ov,r arl Agent's signature to authorize inspection: Delle:
oa�„sgneanv 10/10/2020
Ownert Agent's signature to decline inspection Agmlt. �U Sfwt ,1 Date
Account K2900-5005 Make i:nccr s payable tc CITY OF NEWPORT BEACH