HomeMy WebLinkAboutR2022-0034 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
0 Civic Center Drive I P.O. Box 1768 Newport Beach, CA 92658-8915
RBR# c www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
Application Fee: - $19A b0 Notice:
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%(ForAIIR¢'identialBjtiidingsi % Applications with irisufficienMfeepayment
y-Reinspectltm *ee $'i19.00 - or incomplete will be returned
Please type or print and complete all information
# of Units: Address: 760, Harbor Island Drive City: Newport Beach '.. State: FCA ext he
Property Owner: The A&J Downey Community Property Trust Zip Code:
Owner Address: ! City:
State: L_ Zip Code: C� Home Phone:
Owner's Authorized Agent: Work Phone:
Agent Address: City:
State:�I Zip Code: C_i�� ggent Email Address:
Escrow Company: Freedom Escrow Escrow #: 055132 -MM
Escrow Address: Limo Newport Center Dr., Suite 180 City: Newport Beach
State:CA Zip Code. 92660 Escrow Phone: (949)644-3939
Email Report to: mm@freedomescrow.com
For Inspection call (Name): N/A Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOWI
I authorize inspections and re -inspections of the property listed above. I understand that if Building orZoning
violations are discovered I Will be responsible to correct said -violations:
Owner/Agent's signature to authorize inspection: Date:
l L
OR
Owner/Agent's signature to decline inspection: 4fa
� �w �/�y,A�te:
Account # 01050504-521040 .................Make checks payable to: CITYOF NEWPORT BEACH
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