HomeMy WebLinkAboutR2021-0775 - Permit ApplicationPrint Form City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
�✓7I 100 Civic Center Drive i P.O. Box 1768 1 Newport Beach, CA92658-8915
RBR# " I V tj U www.newportbeachca.gov 1 (949) 644-3200
App icatlon Tor 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: F Address: 501 San Bernardino Ave. City: Newport Beach', State: CA ',Zip: 92663
Property Owner:
The Martelli Family Trust
Zip Code:
92663
Owner Address:
501 San Bernardino Avenue City:
Newport Beach
State: CA
Zip Code: 92663
Home Phone:
Owner's Authorized Agent:
Work Phone: 714-778-5300
Garett Green
Agent Address:
16391
Scientific City:
Irvine
State: FEA
Zip Code: 2618 A
Agent Email Address:
seen@'mrei.com
g�reen@jmrei.com
Escrow Company: I Lennar Title Escrow #:I 195006-000147
Escrow Address: I 5 Hutton Centre Dr #1000 City: ISanta Aan
State: FCA Zip Code: 92707 Escrow Phone: 714-964-5266
Email Report to: gina.simpson@lennartitle.com
For Inspection call (Name): I .. 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 signature to authorize inspection:
Owner/Agent's signature to decline inspection:
Date:
Date: - 2-0 t�
vccou m rF uiusu.�uv-:)zwau .................Make checks payable to: CITY OF NEWPORT BEACH
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