HomeMy WebLinkAboutR2021-0471 - Permit ApplicationDocuSign EnvelopelD: 4A11D6D4-F4C9-4F17-B6AC-7BA779437EC8
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Print Form City of Newport Beach JUN 2 4 2021
COMMUNITY DEVELOPMENT DEPARTMENT
6UIDIVISION
{V/I'yL Y.pVV 100 Civic Center Drive I P.O. Box
ox 1768 � Newport Beach, CA 92658-8915 i?l..ry <i �.
RBR# www.newportbeachca.gov (949) 644-3200
Application for Report of Residential Building Records
Application Fees: Single Family Res/Condo (1 unit)- $165.00 Notice:
Duplex (2 Units) - $192.00 Application with insufficient fee payment
More than 2 units - $192.00 + 11.00 per unit over 2 or incomplete will be returned
Reinspection Fee $88.00
Please type or print and complete all information
# of Units: Address: 485 Morning Canyon Road City: Newport Beach State: CA Zip: 92625-2614
Property Owner: ARC Holdings Zip Code:
Owner Address: City:
State: CA Zip Code: Home Phone:
Owner's Authorized Agent: Melanie Kermode Work Phone: (949) 717-6000
Agent Address: 450 Newport Center Dr., Ste. 100 City: Newport Beach
State:CA Zip Code: 92660 Agent Email Address:
Escrow Company: Key Escrow, Inc. Escrow # 005659 -BR
Escrow Address: 450 Newport Center Drive, 230 City: Newport Beach
State: CA Zip Code: 92660 Escrow Phone: (949)698-1960
Email Report To: Corina@keyescrow.com
for Inspection Call (Name): 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
violations are discovered I will be responsible to correct said violations.
Owner/ Agent's signature to authorize inspection:
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Owner/ Agent's signature to decline inspection: M.t.(.awc iu,ve,o�i.t,
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Date:
Date: 6/24/2021
Account #2900-5005........... Make checks payable to CITY OF NEWPORT BEACH