HomeMy WebLinkAboutR2020-0874 - Permit ApplicationDocuSign Envelope ID: 19C45B76-B51F-42AF-8156-7BBB2FA24015
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COMMUNITY DEVELODEPARTMENT ()c j.
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( SJ7 100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA92658-8915
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Application for Report of Residential Building Recorcfs'fs'r BEpcN
Application Fee: -$194.00 - 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: Address: 3220 Clay street City: Newport Beach j State: CA Zip: 92663
PropertyOwner: Vance P Collins
Zip Code: F.'_
Owner Address: j City:
State: CA_. Zip Code: F Home Phone:
Owner's Authorized Agent: Tim carr Work Phone: 949.631.9999
Agent Address: 450 Newport Center Dr., #100 City: Newport Beach
State: CA Zip Code: 92660 Agent Email Address: tci@timcarrgroup.com
For Inspection call (Name): 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 will be responsible to correct said violations.
Owner/Agent's signature to authorize inspection:
Date:
OR
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Owner/Agent's signatureto decline inspection: �Vau�lt P 66(.V,S Date: 0/1/2020 I 10:52 AM PDT'
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Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
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