HomeMy WebLinkAboutR2023-1003 - Permit ApplicationRECEIVED By
Print Form Cit of Newport Beach COMMUNITY
Y P acDEVELOPMENT
COMMUNITY DEVELOPMENT DEPARTMENT NOV 2 7 2023
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-89&6OF
RBR# R2p7,3 -1063 www.newportbeachca.gov 1 (949) 644-3200 NEWPORT BEACH
Application for Report of Residential Building Records
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: bU AC WC-,rL L. a UVJPrAq,0q City: Newport Beach State: CA Zip: qo,GG 3
Zip Code: 92 Jr92
Owner Address: vl-or VAIYLC—w City: TEIkEcki✓t
State: CA Zip Code: q�s9a- Home Phone: ��(_ 9a1 -Clq .79
Owner's Authorized Agent: ( Ron & Nasrin Delan
Agent Address: 1 2 Ritz Carlton Drive, Suite #201
Work Phone: 949-630-5502
City: I Monarch Beach
State: CA Zip Code: 192629 Agent Email Address:
ihomes@delanrealtors.com
Escrow Company: I Pickford Escrow Company Escrow #:I TBD
Escrow Address: 1 23120 Alicia Parkway, Suite 120 city: I Mission Viejo
State: CA zip code: 92692 Escrow Phone: Nb-586-2700
Email Report to: 1 miss ionviejo@pickfordescrow.com, homes@delanrealtors.com, bvascovich@gmail.com
For Inspection call (Name): I Nasrin Delan
Direct Phone: 1949-630-5502
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/Agent's signature to authorize inspection: C V N-/ Date:) a'-( Au 9-04,3
Owner/Agent's signature to decline
Cs7 7
Date:
Building Division\Fortes\RBfl 8-15 22
Account It 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH