HomeMy WebLinkAboutR2021-0217 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
nn202 2 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
RBR# K I`� � r www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
Please type or print and complete all information
# of Units: Address: 1930 POrt LOCI(Slel h City: [Newport Beach I State: CA Zip: 92660
9 L P I
Property Ownerf Kevin & Kristina Bourke J Zip Code: C�
Owner Address: City:
--. -- --
State: CA Zip Code: C-771 Home Phone:
Owner's Authorized Agent: Work Phone:
Agent Address: j City:
State: F 77 Zip Code: Agent Email Address:
Escrow Company: Freedom Escrow Escrow #: 054496 -MM
Escrow Address:1200 Newport Center Dr., Suite 180 City: Newport Beach
State: FC7A7777., Zip Code:949
( )� 92660 Escrow Phone: 644-3939
I I
Email Report to: mm@freedomescrow.com
For Inspection call (Name): WA Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
violations are discovered I will be responsible:to correct said violations.
`Owner/Agent's signature to authorize inspection: Date:
OR
Owner/Agent's signature to decline inspection: _ 2 " R�/fl6EN7 Date: 3-2LZ-
Account # 01050504-521040 ................. Make checks payable to: CITY OF NEWPORT BEACH
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