HomeMy WebLinkAboutR2023-0948 - Permit Application (3)® City of Newport Beach RECEIVED By
COMMUNITY DEVELOPMENT DEPARTMENT COMMUNO
DEVELOPMENT
BUILDING DIVISION Tn�
100 Civic Center Drive I P.O. Box 17681 Newport Beach, CA 92658-8915' C T 2 5 2023
www.newportbeachca.gov 1 (949) 644-3200
CITY OF
Application for Report of Residential Building Records NFWPOpTBEACH
Application Fee: - $208.00 Notice:
(For All Residential Buildings) Applications with insufficient fee payment
Reinspection Fee $138.00 or incomplete will be returned
Please type or print and complete all information
# of units: Address: 419 Narcissus Avenue City: Newport Beach State: CA Zip: 92625 J
Property Owner: CDM Properties, LLC Zip Code:
Owner Address: City:
State: Zip Code: Home Phone: �—
t
Owner's Authorized Agent: Work Phone:
Agent Address: I I City:
State: Zip Code: Agent Email Address:
Escrow company: Freedom Escrow ! Escrow#: 1 056019-MM
Escrow Address: 1200 Newport Center Dr., Suite 180 city: Newport Beach
State: CA Zip code: 92660 Escrow Phone: (949) 644-3939
email Report to: mm@freedomescrow.com
For Inspection call (Name): I N/A 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 wil I be responsible to correct said violations.
Owner/Agent's signature to authorize inspection: Date:
OR
Owner/Agent'ssignatureto decline
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORTBEACH
Building Division\Forms\RBR_6-15-22