HomeMy WebLinkAboutR2022-0015 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
O��G 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
"/ www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
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: 6 MOOnrISe COUrt, Unit 5 City: Newport Beach State: FCA 92663.
Property owner: Stephen Smurda
Zip Code: 1
Owner Address: - City:
State:.CA Zip Code: E- Home Phone:
Escrow Company: Freedom Escrow Escrow #: 055120 -MM
Escrow Address: 1200 Newport Center Dr., Suite 180 ! city: Newport Beach
- - ach -
State: CA zip Code 92660 Escrow Phone: (949) 644-3939
Email Report to: mm@freedomescrow.com',
For Inspection call (Name): N/A 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 l will be responsible to correct said violations.
Owner/Agent's signatureto authorize inspection: Date:
OR
Owner/Agent's signature to decline inspection: pG�.�M �A Date:
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
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