HomeMy WebLinkAboutR2022-0061 - Permit ApplicationPrait w`sariT City of Newport Beachnm;hZ
a°MuN�
4.m
COMMUNITY DEVELOPMENT DEPARTMENT DFVFtOPMEN!
BUILDING DIVISION
100 Civic Center Drive l P.O. Box 1768 1 Newport Beach, CA926TEB801$2022
RBR# ((I www.newportbeachca.gov 1 (949) 644-3200
CITY OF
Application for Report of Residential Building Recvs
o r w -
Application Fee: - $194.00 Notice:
(For All Residential Buildings) 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: 220 Nice lane #105 I City: Newport Beach � State: CA ,,Zip: J2663
Property Owner The Manuel C Rivera and Camelita R Rivera Family Trust' 1 Zip Code: 092663
Owner Address: 'Z7"12� 1F�1ke.Qnah-,or)c Wb V, fir•. City: 07t(" ''...
State: CA Zip Code: (.� �'��.Y Home Phone: (lQq
Owner's Authorized Agent: Edgar Reynoses Worl< Phone: (949) 614-0404
Agent Address: 2-\'%4 M C1�--r1 t *,-LS-0 City: I k-W�r-sato- N $QGLCh
State: CA._.. Zip Code lr'(1 p4,.. Agent Email Address: dgar92663@gmail.cont
Escrow Company:Escr®w Options Group, Inc Escrow #: 5_7674 -Sq
Escrow Address: 2124 Main St, Ste 250 City: Huntington Beach
State: FU-1Zip Code: 9264$ Escrow Phone: 714-274-2710
Email Report to:
TeamShastin@Escrow0ptions.corn
For Inspection call (Name): Edgar J Reynoso, Esq. Direct Phone: (949) 614-0404
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
II 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 auti'oi it,e inspection: Date:��
Owner/Agents signaturetodecline,inspeetian:Aa
Date:
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
Building D,v......\F.rm,XRBR_}3020