HomeMy WebLinkAboutR2020-0969 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
www.newportbeachca.gov 1 (949) 644-3200
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Application for Report of Residential Building Records
Application Fee: $194.00 Notice: Applications with insufficient fee
payment
Reinspection Fee $ 129.00 or incomplete will be returned
Please type or print and complete all information
# of Units:_ Address:2401 Margaret Drive City: Newport Beach State: CA Zip: 92663
Property Owner: Adam Cancellieri and Kimberly Cancellieri gVCElVr0
Owner Address: 2401 MARGARET DRIVE City: NEWPORT BEACH COMAjtt,-
State: CA Zip Code: 92663 Home Phone: NOV 18 'FCL
Owner's Authorized Agent: Keven Stirdivant Work Phone:
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Agent Address: 1804 Newport Blvd. City: Costa Mesa State: CA Zip Code: 92627
Mobil Phone: Agent Email Address: ks(ftaserealestate.com
Escrow Company: Mariners Escrow Escrow # 59622 -SW
Escrow Address: 270 Newport Center Drive, Suite 200
State: CA Zip Code: 92660
Email Report To: swelker@marinersescrow.com
For Inspection Call (Name):
City: Newport Beach
Escrow Phone: 949-640-6040
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 or Agent's signature to authorize inspection
OR
Owner or Agent's signature to decline inspecti a w Date:
Account # 2900-SO05.................Make checks payable to CITY OF NEWPORT BEACH