HomeMy WebLinkAboutR2022-0186 - Permit ApplicationDocuSign Envelope ID: 0628A532-8774-4F22-8C93-253AC78C31AB
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Print Form City of Newport Beach NPR 05 2022
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA 92658-8915 Q)TY Of
RB R# W www.newportbeachca.gov (949) 644-3200
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Application for Report of Residential Building Records j so
Application Fees: Single Family Res/Condo (l unit) - $198 Notice:
Application with insufficient fee payment
or incomolete will be returned
Please type or print and complete all information
# of Units: Address: 2215 Heather Lane City: Newport Beach State: CA Zip: 92660
Property Owner: Thomas E. Larkin, III, Trustee of the Thomas E. Larkin III Living Trust Zip Code:
Owner Address: City:
State: CA
Zip Code:
Owner's Authorized Agent: Jon
Home Phone:
Work Phone:
Agent Address: 450 Newport Center Drive, suite 100 City: Newport Beach
State:CA Zip Code: 92660 Agent Email Address: JFlagg@VillaRealEstate.com
Escrow Company:
Escrow Address: 450 Newport Center Drive, 230 City:
State: CA Zip Code: 92660
Email Report To: brandi@keyescrow.com
for Inspection Call (Name):
Direct Phone:
Escrow # 006135 -BR
Wharf Beach
Escrow Phone: (949)698-1960
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
I authorize inspections and re -inspections of the property listed above. I under
violations are discovered I will be responsible to correct said violations.
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ed Agent's signature to authorize inspection: USPEC O 10ID�te:
Owner/ Agent's signature to decline inspection:_ [j°8s"' C L.1NEDDate: 4/4/2022
Account #2900-5005 ......... ..Make checks payable to CITY OF NEWPORT BEACH
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