HomeMy WebLinkAboutR2022-0045 - Permit ApplicationYs)'nnrForen, City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
Ipn ^ 01 oo/j 100 Civic Center Drive I P.O. Box 17681 Newport Beach, CA 92658-8915
RBR# IF l/U(iG I www.newportbeachca.gov 1 (949) 644-3200
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Application Fee: - $198.00 Notice:
(For All 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: Address: 564 Sea Wald Rd City: Newport Beach' State: CA Zip: 92625
Property Owner: Louise Weise Zip Code: F—
Owner Address: same City:
State: FCA-
_.. Zip Code: �!. Home Phone:
Owner's Authorized Agent: Janice Arrigo Work Phone: 949.466.3839
Agent Address: 1400 NEWPORT CENTER DRIVE, SUITE 100 City: NEWPORT_ BEACH, CA 92660
State: F Zip Code: F Agent Email Address:
_ )arngo@surterreproperties.com
Escrow Company: Escrow #:
Escrow Address: City:
State: Zip Code: Escrow Phone:
Email Report to:
For Inspection call (Name): Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
I authorize inspections and re -inspections of the property lste'dabove. 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:
OR
Owner/Agent's signature to decline inspection:
Date:
Date:) ..01/26/2022 _
ML�UUii1 n U1v�U�U4-JZ1U4U.................Make checks payable to: CITY OF NEWPORT BEACH
Building Division\Forms\RBR_)-1-21