HomeMy WebLinkAboutR2020-0876 - Permit ApplicationCity of Newport Beach Dl tvev ,,
COMMUNITY DEVELOPMENT DEPARTMENT CWVNIUNITI'
BUILDING DIVISION Dt:.vrl_aPMEN7
l� ��n/��/� Q f, 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-15M O G 2020
RBR# ICLVUJ-DU D www.newportbeachca.gov 1 (949)644-3200
Application for Report of Residential Building Records clTYOF
Application Fee: - $194.E10
otice:
(For All Residential Buildinp) Applications with insufficleatfee payment
Relnspection Fee $129.00 or incomplete will be returned <
Please type or print and complete all information
#ofUnits: Address: 401 FernleafAvenue City: Newport Beach' State: CA Zip: 92625�I
—--- _.- - --- - -- F F l ----i
Property Owner: Gates Fernleaf, LLC - _ — Zip Code:
Owner Address: '... City:
State: CA, i Zip Code. �i Home Phone: ! ,�
Owner's Authorized Agent: '', Work Phone:
Agent Address: City:'
State Zip Code: I Agent Email Address:
Escrow Company: Freedom Escrow '.. Escrow #: 054090 -MM
Escrow Address: 1200 Newport Center Dr., Suite 180 City: LNewport Beach
State: CA —_-_� Zip Code: 92660 Escrow Phone: (949) 644-3939
Email Report to: mm@freedomescrow.com
For Inspection call (Name): NicolarGlazer j Direct Phone: (949) 306-8339 j
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: �ayA��-. Date, fd.�.2JC>Z0
OR
Owner/Agent's signature to decline inspection: Date:—
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
Bundm,DM,Ion\Forms\flea 730-2o