HomeMy WebLinkAboutR2021-0403 - Permit ApplicationCity of Newport Beach " t>!'n nunnry
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION �q�y
100 Civic Center Drive I P.O. Box 17681 Newport Beach, CA 92658-805zn2i
www.newportbeachca.gov 1 (949) 6443200
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Application for Report of Residential Building Rl!o'rdsP\'
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:20402 Santa Ana Avenue. #1 City: Newoort Beach State: CA Zip: 92660
Property Owner: Hideo Hashimoto
Owner Address: - City:
State: -Zip Code: - Home Ph
Owner's Authorized Agent: Andre White Work Phone:
Agent Address: 341 Bayside
Drive,
City: Newport Beach State: CA
Zip Code:
92660
Mobil Phone: (949) 478-7774
Agent Email Address: andre.white0com
asn
s.com
Escrow Company: Mariners Escrow
Escrow Address: 270 Newport Center Drive, Suite 200
State: CA Zip Code: 92660
Email Report To: rmiyamoto@marinersescrow.com
For Inspection Call (Name):
Escrow # 60849 -RM
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
Owner or Agent's signature to decline inspection
Date: 5/26/2021 .,,_,.,,,,.,—
Account # 2900-5005 ................. Make checks payable to CITY OF NEWPORT BEACH