HomeMy WebLinkAboutR2021-0397 - Permit ApplicationgeCL-"IVP'D E2
City of Newport Beach COMM
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COMMUNITY DEVELOPMENT DEPARTMENT UEVELOPMEN7
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915 MAY 2 6 2021
www newportbeachca gov 1 (949) 644-3200
RBR# CITY OF
Application for Report of Residential Building Record%i PORT aeNe
Application Fee: $194.00 Notice: 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:505 1/2 Carnation Avenue City: Newport Beach ( Corona Del Mar Area ) State: CA
Zip: 92625
Property Owner: William M. Russo and Laura A. Russo
Owner Address: - City:
State: _Zip Code:- Home
Owner's Authorized Agent: Casey Lesher Work Phone:
Agent Address: 840 Newport Center Dr. #100, City: Newport Beach State: CA
Mobil Phone: - Agent Email Address: caseylesher(o)amail.com
Escrow Company: Mariners Escrow
Escrow Address: 270 Newport Center Drive Suite 200
State: CA Zip Code: 92660
Email Report To: djohnson@marinersescrow.com
For Inspection Call (Name):
Escrow # 60827 -DJ
City: Newport Beach
Zip Code: 92660
Escrow Phone: 949-640-6040
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 or Agent's signature to authorize inspection Date: ` ,
OR 0 VAX&b6,.
yr
Owner or Agent's signature to decline inspection X��Di�Date:
Account # 2900-5005 ................. Make checks payable to CITY OF NEWPORT BEACH