HomeMy WebLinkAboutR2020-0344 - Permit ApplicationPrint Form City of Newport Beach j(aCEvEj_) A9,G
COMMUNITY DEVELOPMENT DEPARTMENT COMMUNITY
BUILDING DIVISION !X--Vf-LOPMEN7
e100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 926 Wplh 2020
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'0* www,newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Recordsr`ry()F
7:5,
A�Ihqatiion-Fee:-$191.00 Notice: "%RT BOO"
(For All Residential Buildings) Applications with Insufficient fee payment
Reinspection Fee $129,00 or incomplete will be returned
Nease.type or Print and complete all information
#of Units Address:
15 SailcreSt
Property Owner:j Chao Family Trust
City: [Ncwport Beach State: !CA Zip:
[ 92657
`)wner Address
i .-I's, Newport Coast
State: ICA Zip Code: F 92657 Hams Phone,
Owner's Authorized Agent: I Paul Daftarian
Agent Address: 1 3653 E. Coast Hwy,
State 1 CA Zip Code: F9262-5
Zip Code:
Work Phone: 1714-865-5969
City: I Corona Del Mar
Agent Email Address: I paLil@daftartangroup.com
Escrow Company:
Prominent Escrow Escrow#:[06 0558 -SR
Escrow Address: 170 Newport Centel, Drive #150 city: I Newport Beach
'State�CA Zip Code; F92660 Escrow Phone: F949-258-9107
Email Report to: l-s-te-p-l-i-@-p-ro—m-i-n—en-t-e-s-crow.coni of karlao@promineiitescrow.com
For Inspection call (Name): F Direct Phone:
CONSENT TO INSPECT (F_Q �MUST BE SIGNED_&_P_ATED 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:
Date
OR
Owner/Agent's signature to decline inspection: Z1;�1,
-4, 11 v / Date:
Account 4 01050504-521040 - .............Make checks payable to; CITY OF NEWPORT BEACH
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