HomeMy WebLinkAboutR2023-0361 - Permit ApplicationDocuSign Envelope ID: 6DB69AEF-2AEC4E9C-B6D6-2ED16D8223BC
Print Form City of Newport Beach RECEIVED BY
COMMUNITY DEVELOPMENT DEPARTMENT COMMUNITY
DEVELOPMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA9265MOUl 2023
. tow lIzz 3 ^ C3 Ca I www.newportbeachca.gov ( (949) 644-3200
CITY OF
Application for Report of Residential Building RecordwPoRT BEACH
Application Fee: - $202.00 Notice:
(For AIIResidential Buildings) Applications with insufficient fee payment
Reinspection Fee $134.00 or incomplete will be returned
Please type or print and complete
all information
# of Units: f 2 Address:
1 1140 West Balboa Blvd
City: Newport Beach State:
CA 'Zip: F92661
Property owner Montfort Capital Mgmt, LLC Zip code: F33418
Owner Address: 1 13526 Artisian Circle City: FPaIrn Garden
State: cA FL Zip code: 33418 Home Phone: 949-374-3104
Owner's Authorized Agent: I Pacific Sotheby's International work Phone: 1949-500-5641
Agent Address: 10 Monarch Bay Plaza City: Dana Pohl
State: _ CA Zip Code: F92629 Agent Email Address: vip@mmelteam cam
Escrow Company: I Corner Escrow -- - - - - - - Escrow #: I 07-10294-Ds
Escrow Address: I
31706 S. Coast Hwy Ste
# 302
City:
I Laguna Beach
State: CA
Zip Code:
92651
Escrow Phone: 949-313-7333
Email Report to: I donnas@cornerescrow.com
For Inspection call (Name): Donna Szmulo Direct Phone: F949-313-7333
CONSE NT 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 responsibleto correct saiciviolations.
Owner/Agent's signature to authorize inspection: Date:
OR
Doasigned by:
Owner/Agent'ssignatureto decline I Date:4/28/2023
Account # 01050504-521040 .................Make checks payable to: CITYOF NEWPORT BEACH