HomeMy WebLinkAboutR2020-0833 - Permit ApplicationMWCity of Newport Beach RecF.��o
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION SFO �LNipy
100 Civic Center Drive I P.O. Box 1768 1 Newport Beagi, CA924"915
RBR# �ZOQ www.newportbeachca.gov 1 (949) 644-32(5 oPp�„ FCO
Application for Report of Residential Building4 ecol`&
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ApplicationFee: - $194.010 Notice:
(For AltResidahilal Buildings) Applications witltihsufttlent�ft
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Please type or print and complete all information
# of units: C Address: Jasmine Creek Drive City: Newport Beach state: CA zip: 82625
Property owner: James Allumbaugh Zip code:
Owner Address: City:
State: CA �I Zip Code �.. _- - Home Phone:
Owner's Authorized Agent: Work Phone: _ l
Agent Address: City:
_- ---.. ---- ----_----.---. ----------------...--
State: �'i Zip Code: Agent Email Address:
Escrow company:Freedom Escrow Escrow #: 054046 -MM
Escrow Address: 1200 Newport Center Dr_ Suite 180 city: Newport _Beach
State: Cq _ zip code: 92660 Escrow Phone: (949) 644-3939
Email Report to: mm@freedomescrow-com
For Inspection call (Name): N/A Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
I authorize inspections and re -inspections of the property listed 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
Owner/Agent's signature to decline inspection:
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
MIdi n,Dmeion\Forms\RBR J-30-20