HomeMy WebLinkAboutR2021-0474 - Permit ApplicationDocuSign Envelope ID: 7C3BEF4D-OCD2-4A8E-87C4-OAEF81F329DB
Print Form City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
1� 00 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
RBR# 9n�� www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
More than 2 units - $192.00 + 11.00 per unit over 2
Reinspection Fee $88.00
Y,C,EIVED qI,
COMMUNITY
DE:VELOPMEN':
JUN 2 8 2021
CITY OF
1¢WPORT C,F PV
Notice:
Application with insufficient fee payment
or incomplete will be returned
Please type or print and complete all information
# of Units: Address: 7 Crest Circle City: Newport Beach State: CA Zip: 92625
Property Owner: Harold G. Parker and Vicki Lynn Parker Trustees of the Harold G. Parker Family Trust puts
Zip Code:
Owner Address: 2700 Cove Street
State: CA
Owner's Authorized Agent:
Agent Address:
Zip Code: 92625-3209
State:CA Zip Code: Agent Email Address:
City: Corona Del Mar
Home Phone:
Work Phone:
City:
Escrow Company: Key Escrow, Inc. Escrow # 005664 -BR
Escrow Address: 450 Newport Center Drive, 230 City: Newport Beach
State: CA Zip Code: 92660 - 2 Escrow Phone: (949)698-1960
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Email Report To: AYN'Ai (Z' LI OWN
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.
violations are discovered I will be responsible to correct said violations.
Owner/ Agent's signature to authorize inspection* Date
Owner/ Agent's signature to decline inspection: T" i"VI ur Date:
6/25/2021
Account #2900-5005........... Make checks payable to CITY OF NEWPORT BEACH
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