HomeMy WebLinkAboutR2021-0818 - Permit ApplicationPrint Form City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
JI'_( •o
BUILDING DIVISION
4o ZI. o/Jil Q 100 Civic Center Drive I P.O. Box 17681 Newport Beach, CA92658-8915
RBR# 1 UU UU www.newportbeachoa.gov 1 (949) 644-3200
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: 5 Address: 2007 Barranca City: Newport Beach state: zip: 92660
Property Owner:j Scott Hayden zip code: P960
Owner Address: 1 2007 Barranca City: FNewport Beach
State: ICA zip Code: 192657 Home Phone: 949-275-2775
Owner's Authorized Agent: COleen Brennan Work Phone: 1 949-275-2775
Agent Address: 13636CoastHwy city: FCorona del Mar
State:.CA zip Code: F92625 Agent Email Address: coloen,brennan®evmalestate.com
Escrow Company: Gestalt Group Escrow, Inc. Escrow #: 616-cw
Escrow Address: I 203 Argonne Ave., #D
State: F Zip Code: 0603
Email Report to: I cindywiiiigestaitgroupescrow.com
For inspection call (Name): I NIA -declined
City: I Long Beach
Escrow Phone: 714 461-3339
Direct Phone:
CONSENT TO INSPECT IFORM MUST BE SIGNED & DATED BELOW)
I authorize inspections and re -Inspections of the property listed above. I understand that if Building or2oning
violations are discovered I will be responsible to correct said violations.
Owner/Agent's signature to authorize inspection:
Date:�—
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Owner/Agent'ssignaturetodecline inspection: XDate: F —
# 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
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