HomeMy WebLinkAboutR2023-0246 - Permit ApplicationRECEIVED BY
Print Form City of Newport Beach COMMUNITY
DEVELOPMENT
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION MAR 2 S 20D
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
MM V-2pZ3 C)Zct(o www.newportbeachca.gov 1 (949) 644-3200 CITY OF
NEWPORT BEACH
Application for Report of Residential Building Records
Application Fee: - $202.00 Notice:
(For AIIResidential 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: Address: 601 Lido Park Drive 3C City: Newport Beach State: CA zip: 92663
Propertyowner:1 Miranda Phair
Owner Address:
State:ICA
Zip Code: F
Zip Code: F
City:
Home Phone:
Owner's Authorized Agent: Work Phone:
Agent Address: City:
State:
Zip Code: Agent Email Address:
Escrow Company: I Freedom Escrow
Escrow #: 055732-MM
Escrow Address: 1200 Newport Center Dr., Suite 180 city: Newport Beach
State: FCA Zip Code: 92660 Escrow Phone: 1 (949) 644-3939
Email Report to: mm@freedomescrow.com
For Inspection call (Name): N/A 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:
7� �O R ����yy
Owner/Agent's signature to decline ,//�` 2/J. p- ijY%i6�N--Date: 3_2225,
Account It 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
Building _Oivisian\Forms\RBR_6-15-22