HomeMy WebLinkAboutR2023-0949 - Permit Application (3)City of Newport Beach RECEIVED By
COMMUNITY
COMMUNITY DEVELOPMENT DEPARTMENT DEVELOPMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8919CT 2 5 ZQ2;1
RBR# Atfq www.newportbeachca.gov 1 (949) 644-3200
CITY OF
Application for Report of Residential Building Records NEWPORTBEACH
Application Fee: - $208&00
Notice:
(For All Residential Buildings)
Applications with insufficient fee payment
Reinspection Fee $138.00 - -- _ - _--
- - --oirimcomp e� ie wifl returned
Please type or print and complete all information
# of Units: Address: 306-308 E. Bay Avenue City: Newport Beach State: CZip: 92661
Property Owner: Xanadu Coastal Properties, LLC Zip Code:
Owner Address: City:
State: I Zip Code: Home Phone:
Owner's Authorized Agent: Work Phone:
Agent Address: City:
State: Zip Code: Agent Email Address:
Escrow company: Freedom Escrow Escrow #: 056028-MM
Escrow Address: 11200 Newport Center Dr., Suite 180 City: I Newport Beach
State: CA Zip Code: 92660 Escrow Phone: (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:
OR
Owner/Agent'ssignatureto decline, �`f.% Date: 1d G� Z3
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
Bu iIding Division\Forms\RBR 8.15-22