HomeMy WebLinkAboutR2021-0160 - Permit ApplicationDo SI E velope ID: E6959AE5-ECOA-4987-99DE-1282C5FAFD4E
Print Form City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
��V VI -OI �� BUILDING DIVISION
/`/ 1 0 Civic Center Drive I P.O. Box 1768 � Newport Beach, CA 92658-8915
RBR# www.newportbeachca.gov (949) 644-3200
Application for Report of Residential Building Records
Application Fees: Single Family Res/Condo (l unit) - $194 Notice:
Application with insufficient fee payment
or incomolete will be returned
Please type or print and complete all information
# of Units: Address: 712 Malabar - City: Newport Beach State: CA Zip: 92625
Property Owner: Thomas W. O Hearn and Annette O Hearn
Owner Address: City:
State: CA
Zip Code:
Home Phone:
Owner's Authorized Agent: Leo Goldschwartz Work Phone:
Agent Address: 520 Newport Center Drive, Ste 330 City: Newport Beach
State:CA Zip Code: 92660
Agent Email Address:
Zip Code:
Escrow Company: Key Escrow, Inc. Escrow # 005370 -BR
Escrow Address: 450 Newport Center Drive, 230 City: Newport Beach
State: CA Zip Code: 92660 Escrow Phone: (949) 698-1960
Email ReportTo: brandi@keyescrow.com
for Inspection Call (Name):
Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
or
violations are discovered I will be responsible to correct said violations.
Owner/ Agent's signature to authorize inspection: Date:
� 3/3/2021
Owner/ Agent's signature to decline inspection: Ea= ( (�> gwas tu. (h"Date:
Account #2900-5005........... Make checks payable to CITY OF NEWPORT BEACH