HomeMy WebLinkAboutR2022-0058 - Permit Application�kscElveb 6y
PrantForm'COMCity of Newport Beach r1EV OPMIENy
COMMUNITY DEVELOPMENT DEPARTMENT FEB ® 2022
1„� ZZ,0O' BUILDING DIVISION
�1[ /V' 100 Civic Center Drive P.O. Box 1768 Newport Beach, CA 92658-8915
RBR# www.newportbeachca.gov 1 (949) 644-3200 OITYOF
Application for Report of Residential Building Records %PORT g001\
Application Fee: - $198.00 Notice; -
(For All Residential Buildings) Y
Applications with insufficient fee payment
Reinspection Fees 131.00 or Incomplete will be returned
Property Owner:I William and. Bridget Adams Zip Code 960:
Owner Address: F2-0)?—PO?-T CKEL-std— } City.
State: CA Zip Code:2lo b t7 Home Phone: 2p� Ltd Z„r7ic
Owner's Authorized Agent: I Tyler Casey
Agent Address: 3 Monarch Bay Plaza #103 vj City:
State: F CA Zip Code: 92629 I Agent Email Address:
Escrow Company: I Taylor Escrow
Escrow Address: 3 Monarch Bay Plaza #104 _
State: FCA. ": Zip Code: F92629��:
Email Report to: Deldre@taylorescrow.wm
P (Name): Direct Phone:
For Inspection call Name
Work Phone: I 949-295-5169
Dena Point
Tyler@TylersHome.com
Escrow #:I 20-7020-00
City: Dana Point
Md
Escrow Phone: r 949-3808589 EF"
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
I authorize inspections and re -inspections of the property listed above. I understand that if Bi
violations are discovered l will be responsible to correct said violations.
Owner/Agent's signature to authorize Inspection:
Owner/Agent's signature to decline inspectio Date:.
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEA(
Building-aiWSIanlFwmstPBP 1.121
Please type or print and complete
all information
# of Units: 7 Address: F
City: Newport Beach State:
2012 Port Chelsea
CA Zlp:
Property Owner:I William and. Bridget Adams Zip Code 960:
Owner Address: F2-0)?—PO?-T CKEL-std— } City.
State: CA Zip Code:2lo b t7 Home Phone: 2p� Ltd Z„r7ic
Owner's Authorized Agent: I Tyler Casey
Agent Address: 3 Monarch Bay Plaza #103 vj City:
State: F CA Zip Code: 92629 I Agent Email Address:
Escrow Company: I Taylor Escrow
Escrow Address: 3 Monarch Bay Plaza #104 _
State: FCA. ": Zip Code: F92629��:
Email Report to: Deldre@taylorescrow.wm
P (Name): Direct Phone:
For Inspection call Name
Work Phone: I 949-295-5169
Dena Point
Tyler@TylersHome.com
Escrow #:I 20-7020-00
City: Dana Point
Md
Escrow Phone: r 949-3808589 EF"
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
I authorize inspections and re -inspections of the property listed above. I understand that if Bi
violations are discovered l will be responsible to correct said violations.
Owner/Agent's signature to authorize Inspection:
Owner/Agent's signature to decline inspectio Date:.
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEA(
Building-aiWSIanlFwmstPBP 1.121