HomeMy WebLinkAboutR2022-0098 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
RBR# l www.newportbeachca.gov 1 (949) 644-3200
Application 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: I Address: 605 Poinsettia City: Newport Beach I State: CA -;Zip: 82625
Property Owner: The Grams Living Trust Zip code: E
—77
Owner Address: City:
State: CA Zip Code: Home Phone:
Owner's Authorized Agent: �i Work Phone:
Agent Address:':. City:
State L Zip Code: Agent Email Address:I
Escrow Company: Freedom Escrow i Escrow #:1055195 -MM
Escrow Address: 1200 Newport Center Dr., Suite 180 City: Newport Beach
State: Cq Zip Code: 92660 Escrow Phone:(949) 644-3939
Email Report to: mm@freedomescrow.com '.,..
For Inspection call (Name): N/A 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 l will`be responsible to correct said violations.'
Owner/Agent's signature to authorize inspection: Date:
OR
Owner/Agent's signature to decline inspection: ��-- Date:
Account
2 2y Z Z
Account # 01050504-521040 .................Make checks payable to: CITY OFNEWPORTBEACH
Building Division\Farms\RBR 7-1-21