HomeMy WebLinkAboutR2022-0178 - Permit ApplicationDocuSign Envelope ID: 612F7151-6337-4B5D-B231-FE2D578CF894
Print,Formt + City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
Q 100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA 92658-8915
RBR# 2- I V www.newportbeachca.gov (949) 644-3200
Application for Report of Residential Building Records
Application Fee:-$198.00 Notice:
(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
#ofUnits: Address; 2713 W. Balboa Blvd
City: Newport Beach State:
CA Zip: 92663
Property Owner: The
Higgins Family Trust
Zip Coder—
Owner Address: 432
Calle Alto
City: Paso Robles
State:F
Zip Code: 93446
Home Phone: 1 (72.4)390-8300 '
Owner's Authorized Agent: I Nancy Cloward WorkPhone:l (949)606-6116
Agent Address: 34183 Pacific Coast Hwy Ste B City:FDana Point
State: FCA Zip Code: 92629 Agent Email Address: I nancycloward@mac.com
Escrow Company: I The Escrow Source
Escrow #: I 9 916 -MA
Escrow Address: 27611 La Paz Rd Ste D City: Laguna Niguel
State; CA Zip Code: 92677 Escrow Phone: 1 (949) 305-0889
Email Report to: teamrahe@theescrowsource.net
For Inspection call (Name): Nancy Cloward Direct Phone: (949)606-6116'
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 are discovered Iwiil be responsible to correct said violations.
�Dooccu510ued by:
Owner/Agent's signature to authorize inspect! dn, ^lZ _Date: 4/1/2022
6( 4I8_CUNFKC497
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Owner/Agent's signature to decline inspection: Date:
Account # 01050504-521040.................Make checks payable to: CITY OFNEWPORTBEACH
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