HomeMy WebLinkAboutR2021-0450 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
W—Olrob
www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
Application Fee: -$194.00 Notice:
(For AIIResidential Buildings) Applications with insufficient fee payment
Reinspection Fee $129.00 or incomplete will be returned
Please type or print and complete all information
#of Units: Address: 56Talmont Cit Newport�eeach State: CA IZi 92657
Property Owner: Milly W Joe and Edgar L Joe Zip Code: 92657 J
Owner Address:56Talmont City: Newport Coast
State: CA7777 Zip Code: 92657 Home Phone: 323-270-6563
Owner's Authorized Agent: KekA Anderson Work Phone: 949-610-4165
Agent Address: 3857 Birch St #203 Cit : New ort Beach
Stater—' Zip Code: 921 660 Agent Email Address: Keka@Parelnc.com
CA
Email Reportto: I Robin@Remergp.com
For Inspection call (Name): Keka Anderson I Direct Phone: 949-610-4165
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
Owner/Agent's signature to decline inspection: Date:
Account It 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
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