HomeMy WebLinkAboutR2021-0587 - Permit ApplicationPrint Form
City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
�� BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
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www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
Application Fee: - $198.00 Notice:
(For AIIResidential 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: F17
Address: 13 Jasmine Creek Drive City:Newport Beach state: FCA 92625
Property Owner: Robert Vig man, Trustee _ _ Zip Code: l i
Owner Address: City:
State: ICA Zip Coder Home Phone: j
Escrow company: Freedom Escrow Escrow #: 054860 -MM
Escrow Address: 1 1200 Newport Center Dr., Suite 180 city: 5ewport -Beach j
State: FCA Zip code: F92660 j Escrow Phone: 1 (949) 644-3939
Email Report to: mm@freedomescrow.com
For Inspection call (Name): N/A 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 signatureto authorize inspection:
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Date:
Owner/Agent's signature to decline inspection: r'`z��J�(.g//'�ir� S`%/tiovvl Dater %3.12.7(
Account # 01050504-521040 ................. Make checks payable to: CITY OF NEWPORT BEACH
Building Division\Farms\RBR 7-1-21