HomeMy WebLinkAboutR2021-0182 - Permit ApplicationDocuSign Envelope ID: E9589AAC-6C1A-47E9-9CE9-318F313DDA71
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Print Form City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
Vqtj_OI qj 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
RBR# o l.. wwvv, newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
Duplex (2 Units) - $192.00 Application with insufficient fee payment
More than 2 units - $192.00 + 11.00 per unit over 2 or incomplete will be returned
Reinspection Fee $88.00
Please type or print and complete all information
# of Units: Address: 4709 Cortland Drive City: Newport Beach State: CA Zip: 92625
Property Owner: John Viola and Mylinda Viola
Owner Address:
State: CA Zip Code:
Zip Code:
City:
Home Phone:
Owner's Authorized Agent: Katrina Smith Work Phone:
Agent Address: 461 Old Newport Blvd.
State:CA Zip Code: 92663 Agent Email
Escrow Company: Key Escrow, Inc.
Escrow Address: 450 Newport Center Drive, 230
State: CA Zip Code: 92660
City: Newport Beach
Escrow# 005397 -BR
City: Newport Beach
Escrow Phone: (949) 698-1960
Email Report To: brandi@keyescrow.com
for Inspection Call (Name): 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 I will be responsible to correct said violations.
Owner/ Agent's signature to authorize inspection:
Date:
Owner/ Agent's signature to decline inspection: 2117'1- Date: 3/10/2021
Account #2900-5005........... Make checks payable to CITY OF NEWPORT BEACH