HomeMy WebLinkAboutR2021-0612 - Permit ApplicationPrint f=orm City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
b /I 0 � �, O � j ✓� 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
v t/V �l www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
Application Fee: - $198.00 Notice:
(For AIIResidential Buildings) Applications with insufficient fee payment
Reinspection Fee $131.00 or incomplete will be returned
Please type or print and complete all information
#of Units: Address:. _ _ _g _ City: NewportBeach_�! [,Zip: 92660
701 Mar uerite Ave., #2 State: cA
Property Owner: Mark D. Nash, 2013 Trust
Owner Address: 701 Marguerite Ave., #2 I City: corona del Mar
State: CA Zip Code: szsso Home Phone.
zip Code: 92660
Owner's Authorized Agent:Lily
vu, Broker
Work Phone:
714-724-2668
Agent Address:
10588 Angel Ave
City;
Fountain Valley
State:
FGA
Zip Code:
F92708.
Agent Email Address:
lilykvu@gmail.com
Escrow Company: comer escrow Inc. Escrow #: 08 -10285 -VK
Escrow Address: 18600 MacArthur Brod. # iso City: Wine
State: FcA _. Zip Code: 92612. Escrow Phone: 949-800-8908 ext802
Email Report to: Zn. kopac@cornemscmw.com/ 1lykvuQgnnai1.conn
For Inspection call (Name):Lily vu Direct Phone: 714a24 -266e
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:
Owner/Agent's signature to decline inspection:
Building Division\Farms\RBR 7-1-21
OR
Date:
Date: 0/,? 6 / -;l- r......
Account # 01050504-521040 ..... rharkc nnunh/o tnr CITV nF NFWPORT RFdCH