HomeMy WebLinkAboutR2022-0096 - Permit ApplicationDocuSign Envelope ID 751 EE06D-76DB-4AE7-9F8E-2A7FE16A5F68 �r�OEiVEp d,
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Prtntnrm City of Newport Beach COMMUNITY
COMMUNITY DEVELOPMENT DEPARTMENT DEVELOPMENT
BUILDING DIVISION ���j 99
��%/�-.ti2 I7/ 100 Civic Center Drive � P.O. Box 1768 � Newport Beach, CA92658F8�15 s 2022
RBR# L IU www.newportbeachca.gov I (949) 644-3200
CITY OF
Application for Report of Residential Building Record&_ __ &
Cpplication 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
#ofUnits: Address: 47 North Hampton Ct#213 City: Newport.. Beach State CA '.,Zip: 82660__
PropertyOwner: Jack Head, AKA Sidney Head of The Wolfstien Trust Zip Code: 92660
Owner Address: 19 Misty Mdws City: FIrvine
State:CA Zip Code 82612 Home Phone: 949-854-3300
Owner's Authorized Agent Dusty Harris Work Phone: 949-887-2307
Agent Address: 3 Monarch Bay Plaza #103 City: Dana Point
State:_.._ CA .. Zip Code: 92629
Agent Email Address: Dusty@Harcounsprime.com
Escrow Company. Taylor Escrow, Inc Escrow #: 22 -7032 -DD
Escrow Address: 3 Monarch Bay Plaza #104 City: Dana Point
State: CA -- , Zip Code: 92629 ---- --- ---- Escrow Phone: 949-380-6589-- ----- '..
Email Report to. I Deidre@taylorescrow.com
For Inspection call (Name): Direct Phone
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
I authorize inspections and re -inspections of the pro pertyIisted above. I understand that if Building or Zoning
violations are discovered l will be responsible to correct said violations,
Owner/Agent's signature to authorize inspection: Dater
I
DocuSlDned by, R
g g P z,�a,fs Date: /Z 3/2022Owner/A entssi nature to decline ins ection:U,S N"A)'Vt
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
Bu IIding Olvlslon\Forms\RBR 7-1-21