HomeMy WebLinkAboutR2022-0092 - Permit Application,i Fomt City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
q BUILDING DIVISION OV( Z 100 Civic Center Drive 1 P.O. Box 1768 1 Newport Beach, CA92658-8915
l ` www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
Application Fee: - $194.00 Notice:
(For AIIResidential Buildings) Applications with insufficient fee payment
Reinspection Fee $129.00 or incomplete will be returned
Please type or print and complete all information
#ofUnits: Address: 1209 EAST BALBOA BLVD. City: Newport Beach State: CA Zip: g2661
Property Owner:. _BERNIE H. EVANS, III TRUSTEE OF THE EVANS FAMILY TRUST Zip Code: 92661
Owner Address: 1209 EAST BALBO A 8LVID City: NE79RT BEACH
State: CA Zip Code: 92661 Home Phone:
Owner's Authorized Agent: - ALEXIS OSTENSEN Work Phone: 626 445 6137
Agent Address: 128 E. HUNTINGTON DR. #A City: ARCADIA
State: C A _ _ Zip Code: 91006 Agent Email Address: alexiso@designescrow.com
- %{6 alexiso desi nescrow.com
Escrow Company: DESIGN ESCROW INC.. _ Escrow #: 195649-AO
Escrow Address:.) 128 E. HUNTINGTON DR. #A City: ( ARCADIA
State: -.CA Zip Code: 91006 Escrow Phone: 1 626. 445 6137_
Email Report to: I alexiso@designescrow.com
For Inspection call (Name): - t AV - C 4Ah' 1 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 afe discovered I will be responsible to correct said violations.
Owner/Agent's signature
Owner/Agent's signature
Date: � >
Date: �-
Account # U1U50504-521040.................Make checks payable to: CITY OF NEWPORT BEACH
Building Division\Forms\RBR 7-3D-20