HomeMy WebLinkAboutR2022-0187 - Permit ApplicationDocuSign Envelope ID: 79550733-D3AC-4B9F-97AD-9B63A8845F18
Prlat Fol Or - City of Newport Beach rnvED,�
COMMUNITY DEVELOPMENT DEPARTMENT COMMUNITY
BUILDING DIVISION DEVELOPMENT
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 9265 ZOZZ
RBR# www.newportbeachca.gov (949) 644-3200 IN' UU
Application for Report of Residential Building Records CITYOF
Application Fee: = $198.00 Notice: 4�ORT
(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 Units: I Address 433 IRIS AVENUE
City' Newport.Beach State: FCA ZIP: 92625
Property Owner: PRAVIN CHHATRISA Zip Code:433
92625
Owner Address: IRIS AVENUE City: NEWPORT BEACH
State: CA Zip Code: 92625 Home Phone: +1 (949) 233-0700
Owner's Authorized Agent: westl ey Williams Work Phone: 949-290-7995
Agent Address: 190 Newport center Drive, Ste 290 City: Newport Beach
_
State: FA 92660 Zip Code: Agent Email Address: westley@westleywilliams.com
Escrow Company: TAYLOR ESCROW INC. Escrow #: 22 -7077 -DD '..
Escrow Address: 3 MONARCH BAY PLAZA, SUITE 104 City: DANA POINT '..
State: CA ; Zip Code:77" Escrow Phone: 949-380-6589
Email Report to I Deidre@TaylorEscrow.com
For Inspection call (Name) I Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
1 authorize inspections and re -inspections of the property listed above. I understand that if Building orZoning
violations are discovered l wil l be responsible to correct said violations.
Owner/Agents signatureto authorize inspection: Date: F
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Owner/Agent's signatureto decline inspection: DI - ._ Date: 3/30/2022
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Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
Building_Division\Forms\RBP 7-1-21