HomeMy WebLinkAboutR2021-0209 - Permit ApplicationDocuSign Envelope ID: 619B81CC-7175-45C1-A4DA-37370CB236F7
Print Form City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
//��n //tt//�� BUILDING DIVISION
Ko 2l®U GU�V 100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA 92658-8915
RBR# www.newpodbeachca.gov (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: 3611 Seashore Drive City: Newport Beach State: CA Zip: 92663
Property Owner: Kathleen
Owner Address:
State: CA
Zip Code:
Owner's Authorized Agent: Katrina Smith
Agent Address: 461 Old Newport Blvd.
State:CA Zip Code: 92663 Agent Email
Escrow Company: Key Escrow, Inc.
Zip Code:
City:
Home Phone:
Work Phone:
City: Newport Beach
Escrow# 005426 -BR
Escrow Address: 450 Newport Center Drive, 230 City:
State: CA Zip Code: 92660
Email ReportTo: brandi@keyescrow.com
for Inspection Call (Name): Direct Phone:
Beach
Escrow Phone: (949)698-1960
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
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: Kathleen LeGrand Date: 3/23/2021
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Account #2900-5005........... Make checks payable to CITY OF NEWPORT BEACH