HomeMy WebLinkAboutR2020-0505 - Permit ApplicationREVISED
City of Newport Beach �ulvel' 1
Priv# Form • r a -
COr,_c\ ' C>MMUfIITY
COMMUNITY DEVELOPMENT DEPARTMENT i)EVEI.OPMEN7
BUILDING DIVISION
00 Civic Center Drive P.O. Box 17681 Newport Beach, CA 92658* 2020
RgR# www.newportbeachea.gov 1 (949) 644-3200
Application for Report of Residential Building Recogiscarr or-
Anolication Fee: -$191.00 Notice:
(For All Residential Buildings) Applications with insufficient fee payment
Reinspection Fee $129.00 or incomplete will be returned
Please type or print and complete all information
# of Units: r 1 Address: 2230 Newport Hills Drive East City: Newport Beach State: [CA Zip: 92660
PropertyOwner] Pepperdine University,. a. California non-profit corporation Zip Code: 90263-7500.
Owner Address: 24255 Pacific Coast Highway City: Malibu
State: CA Zip Code: 90263-7500 Home Phone: N/A
Owner's Authorized Agent: harles J. Pippin, Sr. Vice President & C.LO Work Phone: 310-506.4000
Agent Address: 24255 Pacific Coast Highway City: Malibu
State: C'' Zip Code: 90263-7500.- Agent Email Address: jeff.pippin@pepperdine.edu
Escrow Company: Corner Escrow, Inc. Escrow H: 09 -9647 -SC
Escrow Address: ( 24310 Moulton Parkwat, Suite E
State: F Zip Code: F92637
City: Laguna Woods
Escrow Phone: 949-767-0009
Email Report to: I _stacy@cornerescrow.com
For Inspection call (Name): Charlie Schutz Direct Phone: 310-601-0372
CONSENT TO INSPECT (FORM MUST BE S16NED & 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 correctsaid violations.
Owner/Agent's signature to authorize inspection:
Pepperdine University, Inc. by:
X 10
Pepperdine University
Owner/Agent's signature to decline inspection:
Date: F
Date:r
Account ff UIUSUSU4-521U4U .................Make checks payable to: CITY OF NEWPORT BEACH
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