HomeMy WebLinkAboutR2021-0792 - Permit ApplicationDocuSlgn Envelope 10: SOC41546-7FC8-45F1-B3B6-2COC87788C45
City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
RBR# VTOA-011/� 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-89fr6:!":
www.newportbeachca.gov 1 (949) 644-3200 1\10\1 J_ ("
2021A-
-1-P,•.,. WIN I naNuTLOY Kesicienria I tsui [ding Records
Application Fee: - $198.00 Notice:
(For All Residential Buildings)s I,4, V"',
Reinspection Fee $131.00 Applications with Insu d"6int1eem pijiment
or incomplete will be returned
Please type or print and complete all Information
# of Units: Address: 12417 Bamboo Street
City: [N�eac� State: [5� !Zip:
_wpor�Be F92660
PropertyOwner:j Nicholas J. Yocca
Zip Code:92660
Owner Address: 2417 Bamboo Street
City: FNewport �Beach
CA Zip Code: Home Phone: F1;4-9�-294-4244
State: F
owner's Authorized Agent: I Wholas J. 'Yoccal Work Phone: 949-294-4244
Agent Address: 132932 Pacific Coast Hwy., #14-161 City: Dana Point
State: Zip Code: F92629 I' Agent Email Address: nickyocca@gmail.com
Escrow Company: The Escrow Source
Escrow a: 9662 -KS
Escrow Address: 27611 La Paz Road, Suite D ;city: Laguna Niguel
State: FCA Zip Code: 92-677 Escrow Phone: 949-305-0888 �
Email Report to: Ksprong@theescrowsource.net & Jeffrey@theescrowsource.net
For Inspection call (Name): Nicholas J. Yocca
Direct Phone:
l949-294-4244
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 Iwill be responsible to correct said violations.
00
owner/Agent's signature to authorize inspection:/15 2021
St by:
Date:
F"
�1-3452728927AB405
OR
Owner/Agent's signature to decline inspection: Date: i
A
----- -- — . ................. IVIUKe cnecKs payaote to: CITY OF NEWPORT BEACH
Building_Diviston\Forms\RBR-7-1-21