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Print Form City of Newport Beach SEP 2.'a iiLt�
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive i P.O. Box 1768 I Newport Beach, CA92658-89i"6I y ve
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Application for Report of Residential Building Records _
Application Fee: - $141.00 Notice:
(For All Residential Buildings) Applications with insufficient fee payment
Reinspection Fee $12%0o or incomplete will be returned
Please type or Print and complete all Information
# of units: F- Address: ( 1725 Plaza Del Sur City: Newport Beach state (CA Zip:F92661
Property owner( Estate of Jeanne Stone Lessard Zip Code: 1,92661 --,
Owner Address 1725 Plaza Del Sur city: Newport Beach
State: CA zip Code: 92661 Home Phone:
Owner's Authorised Agent: I Christopher Allan Frahm work Phone: 1951-453-0633
Agent Address; 1725 Plaza Del Sur city: I Newport Beach v
State: FCA _ Zip Code: ( 92661 `
Escrow company: Alliance Mutual Escrow Inc.
Escrow Address:, 126$1 Newport Ave,
state: rCA Zip Code 927$0
Email Report to: I HeatherLC@ameescrow.com
For Inspection call (Name): _
Agent Email Address: I ckffahm@verizon.net
Escrow N:l 15057HLY
City. I Tustin
Escrow Phone: 1 714.544-6525
Direct Phone,
CONSENT TO INSPECT (FORM MUST BE SIGNED .& DATED BELOWI
I authorize inspections and re-Inspectlons of the property listed above. I understand that if Building or Zoning
violations are discovered lwill beresponsible Acorrecid fol (gDOwnerjAgent's signature to authorize inspection:Date.
Owner/Agent's signature to decline inspection:
Date:; 7-a5—ao;o
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