HomeMy WebLinkAboutR2020-0257 - Permit ApplicationPrint Form City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION'
�y,��p 100 Civic Center Drive j P.O. Box 1768 Newport Beach, CA92658-8915
RBRftC,� t,®s ®7 www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
i Application Fee:. -$191.00 Notice'
(For AllResidential Buildings) Applications with insufficient fee payment
Reinspection Fee S 129.00 or Incomplete will he returned
Please type or print and complete all information
✓F of Units: Address:[ 221 Harbor Ridge Drive #3 City: {Newport Beach state: CA Zip: 92660
Property Owner;�PRF H -Milner _Jr. and Pamela R Mi?ner zrp code: 1�92660.
Owner Address: F21 Harbor Ridge Drive #3 City: I Ne:port Beanch
state: (CA Zi Code: F92660 Home Phone: (949) 874 4020
Owner's Authorized Agent: I Mina Maghanll __. Work Phone: 1 949-874-4020
Agent Address: I F .'` ° °.:'. c` City: Newport Beach ..... _
State: r CA Zip Code192650 Agent Email Address: mmamaghami@gmail.corn
Escrow Company: CORNER ESCROW Escrow#:l 08-9168-vk
Escrow Address 18600 MacArthur Blvd #350 City: Irvine
State-, CA Zip Code: 926G0 Escrow Phone: 949-800-8908
Email Report to: vesna kopar_Cr cornerescrow.com
For Inspection call (Name): Mina Maghaml Direct Phone: 1 949-874-4020
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'ssignaturetoauthorize inspectlon: Date:
OR
Owner/Agent'ssignaturetodecline inspection; �ij4�.-` -_..— Date:
Account # 01050504-521040 ........ ...... ...Moke checks payable to; CITYOF NEWPORT BEACH
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