HomeMy WebLinkAboutR2023-0124 - PermitsPrint Form City of Newport Beach RECEIVED By
COMMUNITY DEVELOPMENT DEPARTMENT DEOMENTMMUNITY
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA 92658Ef1 T 3 2023
Raft (L 202 3 —o) Z y www.newportbeachca.gov (949) 644-3200
CITY OF
Application for Report of Residential Building Recor( WPORTBEACH
Application Fee: - $202.00 Notice:
(For All Residential Buildings) Applications with insufficient fee payment
Reinspection Fee $134.00 or incomplete will be returned
Please type or print and complete all information
# of Units: 1 Address: 605 Bay Hill Dr City: Newport Beach State: CCA Zip:�Q2660
Property Owner:j ,lane Hartmann Trust - Lynn April Hartline, Trustee! Zip Code: 92660
Owner Address: 605 Bay Hill Dr City: Newport Beach
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State: [CA Zip Code: 92660 Home Phone: N/A
Owner's Authorized Agent: I Troy Davis
Agent Address: 1 2211 Tustin Ave
State: CA Zip Code: 192660
Work Phone: 714-264-1334
City: INewport Beach
Agent Email Address: tdavis@theagencyrealty.com
Escrow Company: I TBD Escrow #:
_,.
Escrow Address: City:
State: Zip Code: I I Escrow Phone:
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Email Report to: tdavis@theagencyrealty.com
For Inspection call (Name):
Direct Phone:
. ... .__.... .....
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 I will be responsible to correct said violations.
Owner/Agent's signature to authorize inspection: Date:
OR
Owner/Agent's signature to decline x Date: v^--
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
Bu i Idi ng_Division\Farms\RBR_6-15-22