HomeMy WebLinkAboutR2021-0281 - Permit ApplicationF}ItForm City of Newport Beach or,. i✓
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION 9Y� �akm
V) 2U 7 —O zq100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-891,V-�"r'IVLo vY
RBR# IL C 'U www.newporibeachca.gov1 (949).644-3200 001A MITI
DEVELOPiMEN1.
Application for
Application Fee: - $194.00
(For All Residential Buildings)
Reinspection Fee $129.00
of Residential Building Records
Notice:
Applications with insi
or incomplete will be
Please type or orintand complete all Information
$o(units• 1 Address ( 815 W.. 15th Street #,1 Cltyr Newport Beach I State: CA 'Zip: 92663
Property owner:) Robert and Kathy Taylor.
Owner Address: 815 W. 15th Street #5W
State: CA zip Code: F92663
Zip Code: 92663
City: Newport Beach
Home Phone: 1 949-230-1221
Owner's Authorized Agent:Iu Tom Schulze Work Phone: 949-636-2050
Agent Address:
—T 11
Monstad St city: Aliso ViejO
State:: Ca Zip Code: 92656 Agent Email Address: tschulze7@gmall.Com
Escrow Company; I FrontDoor Closing Services
Escrow Address: 12 Monstad St City;
State: Ca Zip Code: 92656
Email Report to: F FrontDoorCS@teamplayerre.com
Escrow HT FD -4119 -LS
Aliso Viejo.
Escrow Phone: 949-409-4005 ext 704
For Inspection call (Name): L Kathy Tay!Pr ,OwnerDirect Phone: 949-230-1188
j f-("56-2osn
CONSENT TO INSPECT (FORM UST BE SIGNED & DATED BELOW)
I authorize Inspections and re -inspections of the property Ilsted 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: 4/13/2021
OR
Owner/Agent's sign atu re to decline inspection: Date:l��
Account # 01050504-521040 ................. Make checks payable to: CITY OF NEWPORT BEACH
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