HomeMy WebLinkAboutR2020-0901 - Permit Application00I04MNI!'Y
Print Form City of Newport Beach OCT 16 2020
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
e] 100 Civic Center Drive i P.O. Box 1768 1 Newport Beach, CA 92658-691'5
RBR#820220 - 0901 www.newportbeachca.gov 1 (949) 644-3200
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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
#of Units: Address: F1954 Santiago Dr City: Newport Beach State: CA Zip: 92�—
Property Owner. WE1–Lc PA 122-1 Sh pN e�� p.1.(; .�,y.. c.c.E S: v:L ""i cZ-v S-rL•"C vi'
T4{E Fa JP -N EJB- `rZt; S'T-L„r-6�:s�\6D p�c-v rr ^ie, 2_oc 2j Zip Code: 92660
Owner Address: I 1954 Santiago Dr
State: CA Zip Code: 92660
Owner's Authorized Agent: Danielle Purcell
Agent Address: 11190 Glenneyre St
State: CA Zip Code: 92651
EscrowCompany: I Corner Escrow
City: Newport Beach
Home Phone:
work Phone: I 949-7150894
City:j Laguna Beach
Agent Email Address: I dar�i@teamlaguna . com
Escrow Address: I 31706 Coast Hwy, Suite 302
State: FCA Zip Code: 92651
Email Report to: donnas@cornerescrow.com
For Inspection call (Name):
Escrow#:l 07 -8585 -DS
City: I Laguna Bea:~,h
Escrow Phone: 949-313-7333
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:
Owner/Agent's signature to decline inspection: C( �y I.a,GriYt — Date:/ 6%/D'"ppa0
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
Sul mnC_omiston\Forms\RBR 7.30-20