HomeMy WebLinkAboutR2021-0437 - Permit ApplicationPrir t Form .' , ? 11 , City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
(fir BUILDING DIVISION
VIM -
I —aibl _ 100 Civic �enter'Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
RBR# �C U` l ✓ j' t143VVdral /Wvyw.newportbeachca.gov 1 (949) 644-3200
Application Fee: - $194.00 I>EVELOPMENT
(For All Residential Buildings) J'
Reinspection Fee $129.00 JUN 4 2021
of Residential Building Records
Notice:
Applications with insufficient fee payment
or incomplete will be returned
CI7Y O(-
Please type or print and complete all information
FPF e9&
It of Units: Address: 16ShellprintCourt City: Newport Beach State: CA ,Zip: F92663
Property Owne r:..
Noel J. Gonzalez and Jaime L. Sellers
60zR/e� Am; � %-746.1 Zip Code:
9 24 3
Owner Address:
16. Shellprint Court
City:
F NEWPORT BEACH
State
CA
Zip Code.
F92663
Home Phone:
II �949-903-2562
Owner's Authorized Agent Noel J. Gonzalez. Work Phone: 949-903-2562
Agent Address: 16 Shellpdnt Court City: NEWPORT BEACH
State: FCA Zip Code: F92663 Agent Email Address: noelgonzalez@hotnnail.ccnn
Escrow Company: Fidelity National Title Escrow 4: 354113 -TL '..
Escrow Address: 4400 MacArthur Bvld, suite 780 City: Newport Beach
State: F CA Zip Code: 92660 Escrow Phone: 949-766-2836
Email Report to. I _... TLE@ENE COM _ _ ...... _. __. _.... _...
For Inspection call (Name): 0e PP.ZA/e 7 _ Direct Phone: ?L/7 —903 ^,Z54 2—
CONSENT
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
[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:
OR
Owner/Agent's signature todecline inspection: .�/�`f�`�-� .Date: Z02/
s
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
Building Division\Forms\RBR 730 20