HomeMy WebLinkAboutR2021-0494 - Permit ApplicationPrint Form City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
V ilAn tea4 ] 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
RBR# f- W /� U'["� www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
Application Fee: - $198.00 Notice:
(For All Residential Buildings) Applications with insufficient fee payment
Reinspection Fee $131.00 or incomplete will be returned
Please type or print and complete all information
# of Units: Address: 304 Avenida Cumbre City: Newport Beach_ State: CA. Zip: 92660
Property Owner. John and Carolyn Burns Zip Code: 92660
Owner Address: (
304 Avenida Cumbre
City I
Newport Beach
State. CA.
_. Zip Code. F92660
Home Phone: �—
Owner's Authorized Agent: I Kate Colesworthy. Work Phone: I 949-677-6658
Agent Address: 2549 Eastbluff Drive, # 446 '.. City: FNewport Beach
State: FCA Zip Code. 92662 Agent Email Address: I kcolesworthy@msn.com
Escrow Company: I West Coast Escrow Escrow #:) 4530621 -06588 -SEH
Escrow Address: F840 Newport Center Drive, Suite 150 City: Newport Beach
State: FCA Zip Code: F92660 Escrow Phone: 949-759-7072
Email Report to: ( sandi.heben@''wwe^estcoastescrow.com
For Inspection call (Name): 1/� ^ x 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:
No
Owner/Agent's signature to decline inspection:
Account # 01050504-521040 .... .... ._...-.-Mnke rharka nmmhla
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Date:
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