HomeMy WebLinkAboutR2020-0885 - Permit ApplicationDocuSign Envelope ID: 7B6A6503-BCE7496A-93E6-251C9DFA8976
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COMMUNITY
COMMUNITY DEVELOPMENT DEPARTMENT pgvE.LOPMENt
BUILDING DIVISION } 2 202
100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA92658-8§fg
RBR# JO 098c 3S www.newportbeachca.gov (949) 644-3200
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Application for Report of Residential Building Records ��
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Application Fee: - $194.00 Notice:
(For All Residential Buildings) Applications with insufficient fee payment
Reinspection Fee $129.00 or incomplete will be returned
Please type or print and complete all information
# of Units: Address: 1909 Court St. City: Newport Beach State: CA ,Zip: 92663
PropertyOwner. John F. Thomas and Hillary L. Thomas. Trustees
Zip Code:
Owner Address: 17853 Santiago Blvd. # 105 City: FVilla Park
State: CA Zip Code: 92861 Home Phone: 714-998-8300 (office)
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Owner's Authorized Agent: Hillary Thomas, Broker Work Phone: 714-998-8300
Agent Address: 17853 Santiago Blvd. # 105 City: Villa Park
State: FCA Zip Code: 92861 Agent Email Address: Hillary@thomasrealestategroup.com
Escrow Company: Corner Escrow, Inc., C/O Stacy Cope Escrow #. 09 -9996 -SC
Escrow Address: 24310 Moulton Pkwy, Ste E City: Laguna Woods
State: CA Zip Code: F2637 Escrow Phone: 949-767-0009 W
Email Report to: Stacy@cornerescrow.com
For Inspection call (Name): Hillary or Jordan Direct Phone: 714-998-8300.
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 responsibleto correct said violations.
D --_._i ocuSigned by:.i-I� Tu
Owner/Agent's signature to authorize inspection:—El-� Iu.otxaS Date: 10/8/2020
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OR
Owner/Agent's signature to decline inspection:
Buudln oWslon\Forms\RBR 7ao-20
Date: �.�._-...._.... _.
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH