HomeMy WebLinkAboutR2021-0393 - Permit ApplicationCITY OF NEWPORT BEACH vtvu �j,
COMMUNITY DEVELOPMENT DEPARTMENT wo�noUNl[y
BUILDING DIVISIONwtnueru�
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
www.newportbeachca.gov 1 (949)644-3200 M�Ay 26 2021
RBR# N61(WS
-
CFR' OF
Application for Report of Residential Building Records 4�'"'P )RT
Application Fee: $194.00 Notice:
(For All Residential Buildings) Application with insufficient fee payment
Reinspection Fee $125.00 or incomplete will be returned
Please type or print and complete all information
Number of units: 1 Street Address: 501 Playa
Property Owner: Nancy L. Carpenter Zip Code:
Owner Address: Same
Street City
Home Phone: 949)533-0792 Work Phone:
Owner's Authorized Agent: Kate Colesworthy, Colesworthy Real Estate Services
Agent Address: 2549 Eastbluff #446, Newport Beach, CA 92660
Work Phone: 949 677-6658
Escrow Name and Address: West Coast Escrow, Escrow No. 4530621-04966 - SEH
Escrow Address: 840 Newport Center Drive, Suite 150, Newport Beach 92660 Escrow Phone: (949) 759-7072
Email Report to: SANDI.HEBENCa WESTCOASTESCROW.COM
For Inspection Call (Name): DECLINED
CONSENT TO INSPECT (FORM MUST BE SIGNED AND 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
Date
OR
Owner/Agent's signature to decline inspection - ";i- —_ Date
Account #01050504-521040............ Make checks payable to CITY OF NEWPORT BEACH