HomeMy WebLinkAboutR2022-0080 - Permit ApplicationPrint Form City of Newport Beach ocOVED k?).
COMMUNITY DEVELOPMENT DEPARTMENT COMMUNITY
BUILDING DIVISION DEVELOPMENY
�n a �R 1 A6Gb 100 Civic Center Drive I P.O. Box 1768 I Newport Beach, CA92 8911 Z6ZZ
RBR# UU 6Y 0 D www.newportbeachca.gov 1 (949) 644-3200
Application tor Report of Residential Building Recordi"'
ARR icetlon —Fee-- $198.00 WPORT eeA
Notice:
(For spectlll Residential 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: I Address: iOcean 2828glv
Property Owner:j Mark Vaklll, Trustee
Owner -Address; 5401 Quail St #105
State: I`" Zip Code: F 92260
Owner's Authorized Agent:
Agent Address:
State:
n/a
Zip Code:
Escrow Company: if Doma Title
Escrow Address: 1711 W. Kimberly Ave #200
State: F CA pT m Zip Code: 92870
Email Report to: 1 maria.raab@doma.com
For inspection call (Name):
City: Newport Beach state: CA zip: 92660
city: I Newport Beach
City:
Agent Email Address:
Zip Code:
Home Phone:1 9496786000
Work Phone:
Escrow #:1 95004-22-04266
city:I Placentia
Escrow Phone: 949419-9460
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: Date:
OR
Owner/Agent's signatureto decline inspection: ( C,j ___,. Date:l Z�J�
Account n U1U5U5U4-511040 .................Make checks payable to: CITY OF NEWPORT BEACH
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