HomeMy WebLinkAboutR2021-0204 - Permit ApplicationDocuSign Envelope ID: 29F888CD-BAC2-48FC-8131-7FEEAB5F6BB8
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COMMUNII"Y
DEVELOPMENT
MAR 18 2021
Print Form City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
�n 2 BUILDING DIVISION CITY OF
p/ Q 00 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-891
RBR# Y 8®o 2 o www.newporlbeachca.gov 1 (949) 644-3200 11/F,ORI Bf-INI ;'h
Application for Report of Residential Building Records
Application Fees: Single Family Res/Condo(1 unit) -$165.00 Notice:
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
# of Units: Address: 21
Please type or print and complete all information
City: Newport Beach State: CA Zip:
Property Owner: Echo Beach, LLC
Owner Address: City:
State: CA Zip Code:
Owner's Authorized Agent: Kristina Heimstaedt
Agent Address: 450 Newport Center Dr., Ste. 100
State:CA Zip Code: 92660 Agent Email Address:
Escrow Company: Key Escrow, Inc.
Zip Code:
Home Phone:
Work Phone: (949) 717-6000
City: Newport Beach
Escrow # 005415 -BR
Escrow Address: 450 Newport Center Drive, 230 City: Newport Beach
State: CA Zip Code: 92660 Escrow Phone: (949) 698-1960
Email Report To:
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:
Owner/ Agent's signature to decline inspection: g/f9 -,-,n,6 Date:
3/18/2021
Account #2900-5005........... Make checks payable to CITY OF NEWPORT BEACH