HomeMy WebLinkAboutR2022-0176 - Permit ApplicationDocuSign Envelope ID: 136A1752-OC33-4A7C-A4D5-85E7BF2F2253
Print Form City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
�O` I �/„ 100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA 92658-8915
RBR LL OJ www.newportbeachca.gov (949) 644-3200
Application for Report of Residential Building Records
Duplex (2 Units) - $192.00 Application with insufficient fee payment
More than 2 units - $192.00 + 11.00 per unit over 2 or incomplete will be returned
Reinspection Fee $88.00
Please type or print and complete all information
# of Units: Address: 2592 Circle Drive
City: Newport Beach State: CA Zip: 92663
Property Owner: Kenneth S. Alston and Mackenzie K. Alston, as Trustees of the Alston Family Trust dated March 11,
2013 Zip Code:
Owner Address:
State: CA Zip Code:
Owner's Authorized Agent: Steve H
City:
Home Phone:
Work Phone: (949) 717-6000
Agent Address: 450 NewportCenter Dr., Ste. 100 City: Newport Beach
State:CA Zip Code: 92660 Agent Email Address: shigh@villarealestate.com
Escrow Company: Key Escrow, Inc.
Escrow # 006134 -BR
Escrow Address: 450 Newport Center Drive, 230 City: Newport Beach
State: CA Zip Code: 92660 Escrow Phone: (949)698-1960
Email Report To: brandi@keyescrow.com
for Inspection Call (Name):
Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
violations are discovered I will be responsible to correct said violations.
Owner/ Agent's signature to authorize inspection:
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Owner/ Agent's signature to decline inspection: EsK:WCL1 EL))ate:
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that if Building or Zoning
4/4/2022
Account #2900-5005........... Make checks payable to CITY OF NEWPORT BEACH