HomeMy WebLinkAboutR2020-0811 - Permit ApplicationDocuSign Envelope ID: BA1DEBIC-CDBA-4762-82EF-OB9B1D5DFCO2
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l� i t Qsm City of Newport Beach COMMUNITY
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COMMUNITY DEVELOPMENT DEPARTMENT SEP 17 RECD
BUILDING DIVISION
qq rr// 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8�l5 DEvELOPMrNT
RBR# �L6�O` 6UI� www.newportbeachca.gov 1 (949) 644-3200 {- G.r
Application for Report of Residential Building Records �FNEWPoa, la;plP
Application Fee: -.$191.00 - 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
ItofUnits: Address: 1716 Santiago Drive _. City: Newport Beach'. State: CA Zip: 92660
Property Owner: Holland 2004 Family „Trust _.._ _.. _.._ Zip Code:,,
Owner Address:; City:
State: CA..,. _ Zip Code: �` --- --- Home Phone: .
Owner's Authorized Agent: Tim Carr Work Phone:
Agent Address: 450 Newport Center, Ste 100 '', Citj NB, CA 92660
State: F Zip Code: F Agent Email Address: tci@timcarrgroup.com (949)631-9999
Escrow Company Granite Escrow Escrow#: I_
Escrow Address: 450 Newport Center Drive, Suite 600 City: NB, CA 92660 '..
State: F Zip Code: I Escrow Phone: 949.415-5760
Email Report to: jmcmillan@graniteescrow.com
For Inspection call (Name): Direct Phone:
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 responsible to correct said violations.
Owner/Agent's signature to authorize inspection: Date: F.'_..
OR
Owner/Agent'ssi nature to decline inspection: r
g p Date: a/v/zozo 10:22 AM PDT
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Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
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