HomeMy WebLinkAboutR2020-0883 - Permit ApplicationM�
�City of Newport Beach u vn un,rry
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COMMUNITY DEVELOPMENT DEPARTMENT r." V" `7pmr. n37
BUILDING DIVISION OCT 1 5 2020
n v Q100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-891
IL ° J www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Recfrd. - pc�
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: n Address: +C -�"'� .("� f-t�l�-�-L��� i� City: Newport Beach State: CA !Zip: �I i
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Pro perty Owner: SL Irl.-.LIpY?Cf cY15 1�I t—f-Vii.+(.----� Zip Code: Lf-_-.....-)
Owner Address: C 1._�%i%_ItYAKt It.- SIE I9G✓f---',fk6 .-----
1� - G City: �L'
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State: CA T; Zip Code: 6''Z� Home Phone:.
Owner's Authorized Agent: Gyre ( Work Phone:
Agent Address: .UV{P.!-V City: �,L'l%U!'-�11
I+ky� i`\ -cwt Graiu:t..12¢m+r��u —
State: FC I Zip Code: �' 99��� ii ;;
! ___!:'f��l.P Agent Email Address:
Escrow Company Blue water Escrow Inc. Escrow It:
Escrow Address: 1400 Nesport Center Dr. #125 Clty: Ne.+port Beach
State: ch Zip Code 92660 Escrow Phone: 949-478-7900
Email Report to:
p anon@blueerater------ .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 l will be responsible to correct said violations:
Owner/Agent's signature to authorize inspection: Date:
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OR
Owner/Agent's signature to. decline inspection: Date: l(j_.- �--a)
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
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