HomeMy WebLinkAboutR2022-0044 - Permit ApplicationPrint Form City of Newport Beach Acelver)
COMMUNITY DEVELOPMENT DEPARTMENT COMMUNITY
BUILDING DIVISION DEVELOPMENT
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92651AY8
2022
RBR# (� �j ISG www.newportbeachca.gov 1 (949) 644-3200 IV
Application for Report of Residential Building RecordsrCITYOF
Application Fee: - $198.00 Notice: 41�VI'ORT F3EP011
' (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 Units4101 Address: 971 BAYSIDE COVE WEST City: Newport Beach j state: CA ,'Zip: 92660
PropertyOwner: LINDA EBERLY 2002 TRUST Zip Code: F
Owner Address: PO BOX 2144 City: FoRLEANS, MA
State: CA MA Zip Code: F 02653 Home Phone: (781)953-1446
Owner's Authorized Agent: ALLIANCE INVESTMENT REAL ESTATE Work Phone: (714) 293-6194
Agent Address: 4425 JAMBOREE ROAD, SUITE 240 City:NEWPORT BEACH
State: F CA Zip Code: 92660 Agent Email Address:11
DAN ALLIANCERE.COM
Escrow Company: Fidelity National Title Escrow #: 375902 -TL
Escrow Address: 4400 MACARTHUR BLVD, STE 780 City: FNEWPORT BEACH
State: CA Zip Code: F92660 Escrow Phone: (949)788-2836
Email Report to: I TLE@FNF.COM
For Inspection call (Name): Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
I authorize inspections and re -inspections of the property listed above. l 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: {qV Date: I lzj wY
01
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
Widin,Dwkian\Forms\RBR_7-1-21