HomeMy WebLinkAboutR2021-0392 - Permit ApplicationPrint Form City of Newport Beach COMIMUNITv
COMMUNITY DEVELOPMENT DEPARTMENT is VELOPNL:N
BUILDING DIVISION by y �O)
AM 100 Civic Center Drive I P.O. Box 1768 � Newport Beach, CA9265' - 9{5
RBR# _l _ www.newportbeachca.gov (949) 644-3200
Application for Report of Residential Building Recond
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
#ofUnits: I Address:F3 Nautical Mile Drive City: [Newport Beach State: iCA Zip:52663
PropertyOwner:j Payam and Rozina Sohrab
Owner Address: 15 Highpoint
State: FCA Zip Code: 92657
owner's Authorized Agent: I Stephanie Ciulla
Zip Code: 92657
City:I Newport Coast
Home Phone: (714) 588-5689
WorkPhone: 1 (949) 212-6670
Agent Address:
12603 Camino Ramon,
Suite 200 Clty:)
San Ramon
State:j
CA
Zip Code:
94583
Agent Email Address:
Fstephanieshomes@gmail.com
Escrow Company: I THE ESCROW SOURCE, INC.
Escrow Address:I 27611 LA PAZ ROAD, SUITE D
State: CA Zip Code: I 92677
Email Report to: I NI COLE@THEES CROWS OURCE. NET
For Inspection call (Name): I Stephanie Ciulla
Escrow#:] 009245 -SM
City: I LAGUNA NIGUEL
EscrowPhone: (949) 305-0888
Direct Phone: 1 (949) 212-6670
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
LEI
by
l:
Owner/Agent's signatureto decline inspection: IA.v�ai4 Date: 5/24/2021
Account p 01050504-521040 .................Make checks payable to: CITYOF W IMPORT 9tACH
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