HomeMy WebLinkAboutR2021-0476 - Permit Application14,
rIn rarm City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
M O) 'y- „ 100 Civic Center Drive I P.O. Box 1768 Newport Beach,
RBR# Q T �/ www.newportbeachca.gov 1 (949) 644-3200
COMMUNITY
DEVELOPMENT
Cf{92'65898MY
CITY OF
Application for Report of Residential Building It c &
Application Fee: - $191.00 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
#of Units: Address: 420 Harbor Island Drive City: Newport Beach state: FCA 92660-7231
PropertyOwner:
Joseph Poppler
Zip Code:92660-7231
Owner Address: 1
420 Harbor Island Drive
_
City:
Newport Beach
State: CA Zip Code: 92660-7231
_
Home Phone:
Owner's Authorized Agent Coleen Brennan
Work Phone: 949-275-2775
Agent Address:
3636 E. Coast Hwy.
City:
I Corona del Mar
CA .�
State _ I Lp Code. 92625 Agent Email Address:co lean, brennan@evrealestate.com
Escrow Company: Gestalt Group Escrow,Inc Escrow #: 1524-cw.
Escrow Address: 203 Argonne Ave., #D,_ City: Long Beach
State:._ __ CA I Zip Code: F 90803 Escrow Phone 1714-461-3339
Email Report to. cindyw@gestaltgmupescmw.com
For Inspection call (Name): Direct Phone:
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: Dater-
Owner/Agent's signature to decline inspection:
4A-L�
Date: BVI u
leez
Account # 01050504-521040 .................Make checks payable to: CITyOF NEWPORT BEACH
Bullding Division\Forms\RBR_9 18-18