HomeMy WebLinkAboutR2022-0079 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
�gO17_ d§j vic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
RBR # www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
Application Fee: - $198.00 Notice:
(For All Residential Buildings) Application with insufficient fee payment
Reinspection Fee $131.00 or incomplete will be returned
Please type or print and complete all information
# of Units: Address: 701 & 701.5 Larkspur Avenue
City: Corona del Mar
State: CA Zip: 92625
Property Owner: the Zehner Family Trust Dated August 6, 2003 Zip Code: 92625
Owner Address: 224 Iris Ave.
State: CA Zip Code: 92625
City: Corona Del Mar
Home Phone: 949-724-2000
Owner's Authorized Agent: Conrad Peterson Work Phone: 949-500-7788
Agent Address: 840 Newport Center Drive, Suite 100 City: Newport Beach
State: CA Zip Code: 92660 Agent Email Address: con rad &conrad Peterson. com
Escrow Company: West Coast Escrow
Escrow Address: 840 Newport Center Dr., Ste.150
State: CA
Zip Code: 92660
Email Report to: team heben(lj)westcoastescrow.com
Escrow #: 4530622-01087 - SEH
City: Newport Beach
Escrow Phone: (949) 759-7072
For Inspection call (Name): N/A Direct Phone: N/A
CONSENT TO INSPECT (FORM MUST BE SIGNED AND DATED BELOW)
Iauthorize 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: Date
OR /
Owner/Agent's signature to decline inspection: C or✓ 1f0,6z y7p>(� �cI1� Date „J
Agent for Owner
Account #01050504-521040.. _ Make rherka nnvnhln tn- CITY OF NFWPORT RFACH
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