HomeMy WebLinkAboutR2022-0179 - Permit ApplicationDocdSign Env^lope ID: 612F7151-6337-4B5D-B231-FE2D578CF894
, COVEL) By
COMMUNITY
DEVELOPME
City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT APR 0 4 2022
BUILDING DIVISION
�q1 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-89&�yOF
RBR#I N www.newportbeachca.gov1(949)644-3200 +-k�,x,
ORT BEPG
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
#of Units: F Address: 127 27th Street City: Newport Beach State: CA Zip: 92663
Propertyowner:I The Higgins Family Trust
Owner Address: 432 Calls Alto
State: CA Zip Code: F93446
Zip Code: I--�
City: I Paso Robles
Home Phone: (714) 390-8300
Owner's Authorized Agent: I Nancy Cloward Work Phone: I (949)606-6116
Agent Address: 34183 Pacific Coast Hwy Ste B city: Dana Point u —
State: CA Zip Code: F92629 Agent Email Address: I nancycloward@mac.com
Escrow Company: I The Escrow Source
Escrow Address:) 27611 La Paz Rd Ste D
State: CA Zip Code: F92677
Email Reportto; I teamrahe@theescrowsource. net
For Inspection call (Name): I Nancy Cloward
Escrow#:l 9922-MA
city; j Laguna Niguel
Escrow Phone: 1 (949) 3 0 5 - 0 8 8 9
Direct Phone: 1 (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 orZoning
violations are discovered I will be responsible to correct said violations.
Owner/Agent's signature to authorize
Owner/Agent's signature to decline ins
Date: 1 4/1/2022
Date: F—
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
Building DMsm\Forms\R8R 71-21