HomeMy WebLinkAboutR2022-0091 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
q A /� I 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
RBR# 1` WT? 6 "1 www.newportbeachea.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: Address. 11 Scotia Sea City: Newport Beach ' State: CA ,Zip: 82657
- . - 5,
Propertyowner: William S. Ashmore
Zip Code:
owner Address: 11 Scotia Sea city: Newport Coast
State: CA Zip Code: 92657 Home Phone: (949) 795-1576 x
Owner's Authorized Agent: I John Cain Work Phone: 714-655-8940
Agent Address: 1200 Newport Center. Dr, Ste 100 city: F Newport-13-each-
State:
ewportBeachState: F CA Zip Code: F92660 Agent Email Address: John@caingroup.com
Escrow company: Stewart Title of California, Inc Escrow #: 1591783
Escrow Address: 1900 S. State College Blvd #200 city: Anahei
.heim
State: CA Zip Code: 92806 Escrow Phone: 949-224-8616
Email Report to: Pace. Burrell@stewart.com
For Inspection call (Name): William S. Ashmore Direct Phone: (949) 795-1576
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 correctsaid violations.
Owner/Agent's signature to authorize inspection:
Owner/Agent's signature to decline inspection:
BuilEingpivislon\Forms\RBI[_]-1-21
OR
Date:
Date:
Account # 01050504-521040 .................Make checks payable to: CITY Of NEWPORT BEACH