HomeMy WebLinkAboutR2022-0040 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
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100 Civic Center Drive P.O. Box 1768 1 Newport Beach, CA 92658-8915
RBR# www.newportbeachca.gov 1 (949) 644-3200
Ar,nlirntinn for Report of Residential Building Records
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Application Fee: - $198.00 - Notice:
(For AllResidential Buildings) Applications with insufficient fee payment
Reinspection Fee $1`31.00 or incomplete will be returned
Please type or print and complete all information
#ofUnits: Address: Ll601 Highland Drive City: Newport Beach State: CAZip: 92660 j
Property Owner] Heather Homes, LLC
Zip Code:
Owner Address: City:
—........ -.1 --
State: CA_7_7] Zip Code: Home Phone -.-
Owner's Authorized Agent: work Phone:
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Agent Address: City:
State: �) Zip Code: F777, Agent Email Address:
Escrow Company: Freedom Escrow Escrow #: 055138 MM J
Escrow Address: 1200 Newport Center Dr., Suite 180 City: Newport Beach_____
Escrow Phone: 949 644-3939 i
State: Cq zip code: 92660. (
Email Reportto: imm@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 twill be responsible to correct said violations.
Owner/Agent's signature to authorize inspection: Date:
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OR
Owner/Agent's signature to decline inspection: yA60%.0' Date: F/ ZS•22 J
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
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