HomeMy WebLinkAboutR2021-0817 - Permit ApplicationPdntForm City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
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BUILDING
1761 1 SION
New
100 Civic Center Drive I P.O. Box 1788 I Newport Beach, CA 92658-8915
RBR# www.newportbeachca.gov1(949)644.3200
Application for Report of Residential Building Records
Application Fee: - $198.00Notice:
(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
#ofUnits: Address: 3 Ocean Heights Drive City: Newport Beach state: Zip: 92657
Property owner: Gene E. Baxter and Marty Alice Splendore -Baxter zip code: 92657
Owner Address: 1 3 Ocean Heights Drive CityNewport Beach
State: F Zip Code: 92657 Home Phone: I gbaxter39@gmail.com
Owner's Authorized Agent: Coleen Brennan work Phone: 1 949-275-2775
Agent Address: 13636 Coast Hwy city: Fcoronadel Mar
State: CA Zip Code: 92625 Agent Email Address: I coleen,brennan@evrealestate.com
Escrow Company: Gesta# Group Escrow, Inc. I Escrow M 11614 -CW
Escrow Address: I 203 Argonne Ave., #D
State:CA Zip Code: 90603
Email Report to: I cinrlyw®gealaltgroupescrow.com
For Inspection call (Name): I NIA - declined
City: I Long Beach
Escrow Phone: 714 461-3339
Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
I authorize Inspections and re -Inspections of the property listed above. l understand that if Building orZoning
violations are discovered I will be responsible to correct said violations.
Owner/Agent's signatureto authorize inspection: Date: I
OR
owner/Agent's signature to decline inspection: x �,i Date:'
Account# 01050504-521040 ................. Make checks payable to: CITY OF NEWPORT BEACH
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