HomeMy WebLinkAboutR2023-0972 - Permit ApplicationDocuSign Envelope ID: F45BBBE5-BD9E-4153-B903-55F275AB25CC
RECEIVED BY
Print For City of Newport Beach COMMUNITY
DEVELOPMENT
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION NOV 0 9 Z023
n�I
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
RBR# QjM'3 —d4?2 www.newportbeachca.gov 1 (949) 644-3200 CITY OF
NEWPORT BEACH
Application for Report of Residential Building Records
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: F— Address: 700 Acacia Avenue
PropertyOwner:I Gunes D. Jones
Owner Address: 1 700 Acacia Avenue
State: CA Zip Code: 92625
Owner's Authorized Agent: I Asemo Smiley
City: Newport Beach State: CA Zip: 92625
Zip Code: F92625
City I Corona Del Mar
Agent Address: 1 33522 Niguel Rd #200 City:
State: FEAT
Zip Code: 92629 Agent Email Address:
Escrow Company: I Corner Escrow, Inc
Escrow Address: 1 31706 Coast Hwy, Suite 302
State: FzA zip code: 92651
Email Report to:' donnas@cornerescrow.com
For Inspection call (Name):
Home Phone: 1 949-933-9572
Work Phone: I 949-310-7300
Monarch Beach
asemo.smiley@compass.com
Escrow #: 07-10559-DS
City: I Laguna Beach
Escrow Phone: 1 949-313-7333
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:l
OR
Doc SM edd by:
Owner/Agent's signature to decline �AWtds V. jbin.I,s Date: 11/8/2023
�—F4FD9CF4B]434BD._
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
Building DNSIan\Forms\RBR 6-15-22