HomeMy WebLinkAboutR2020-0921 - Permit ApplicationPrint Form City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
RBR# J� O •-u 4�t ` www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
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
#ofUnits: I Address: F28 Dunes Bluff
City: Newport Beach State: CA Zip: F 92657
Property Owner: EuroPacifc Property Investment LLC Zip Code: 92651
Owner Address: 1000 North Coast Hwy Suite # 1 City: FLaguna Beach
State: CA Zip Code: F92651 Home Phone: (949) 524-9162
Owner's Authorized Agent: Work Phone: I
Agent Address: I City:
State: F Zip Code: F Agent Email Address:
Escrow Company: I Encore Escrow Company, Inc. Escrow #: I 01441 -PJ
Escrow Address: I 9200 Sunset Blvd. # 207 City: I West Hollywood
State: F CA Zip Code: 90069 Escrow Phone: (310) 461-0480
Email Report to: Peter Joun - Peter@EncoreEscrow.com
For Inspection call (Name): Patrick Piens Direct Phone: 1 (949) 524-9162
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.
Owner/Agent's signature to authorize inspection:
Owner/Agent's signature to decline inspection:
Building_ Divisionvorms\11BR_7 30-20
Date:
Date: November 2, 2020
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH