HomeMy WebLinkAboutR2020-0818 - Permit ApplicationRt Cslvso ADS,
City of Newport Beach CoMlwuNrry
COMMUNITY DEVELOPMENT DEPARTMENT SEP 2 3 RECD
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 17681 Newport Beach, %92,, 8-8915
RBR# Q `011y www_newportbeachca.gov ( (949) 644-3200 ?� ELOPMEN'rro
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Application for Report of Residential Building Records
Application Fee: - $194.00 Nntira-
Please type or print and complete all information
# of Units: Address: 1812 POrt Taggarf_Place ) City: Newport Beach State Zi: p 82660.
Property owner: Kyle Rayden Anderson Trust zip code: 92660
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Owner Address: 1. 1812 Port Taggart Place i Cite Newport Beach
State: zip Code. 92660 Home Phone: 949-246-1632
Owner's Authorized Agent: Holly Duplanty - work Phone: I 949-300-5118 —
Agent Address: 1400 Newport Center Drive #100 city: Newport Beach
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State: CA Zip Code: 9
72 6 6 071 Agent Email Address: hduplantY surterreproperties.com
Email Report to: jason@bluewaterescrow.com
For Inspection call (Name): Direct Phone: I
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
1 authorize inspections and Ye -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: Date:
74OR
Owner/Agent'ssignature to decline inspection: Date: q, -,�a,,
Account If 01050504-521040...........41.. Make checks payable to: CITY OF NEWPORT BEACH
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