HomeMy WebLinkAboutR2022-0183 - Permit ApplicationAoSiVED Hy
COMMUNITY
City of Newport Reach DEVELOPMENT
COMMUNITY DEVELOPMENT DEPARTMENT APR 05 2022
BUILDING DIVISION
100 Civic Center Drive I P.O, Box 1768 1 Newport Beach, CA 92$58-8915
RBR# www.newportbeachca.gov 1 (949) 644-3200 CITYCF
Application for Report of Residential Building Records"14POAT eEPc�
Applicatipn Fee: -$108.00 Notice:
(Fo?AIi Residential Buildings) Applications witginsufficient fee payment
Rofnspection Fee $131.00 or incomplete will be returned
Please type or print and complete all information
# of Units: Address: 3803 Marcus Avenue City; Newport:aeach { state:CA .,Zip: 92663
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Property owner: William Scott Upshall, Trustee zip Code:
Owner address: 20 Toyon Lane city: Newport Beach
18
State: CA , Zip Code 92663 Home Phone: .I
Owner's Authorized Agent. I Tim Smith / Coldwell Banker Work Phone: 949-478-2295
Agent Address: 840 Newport Center Dr., Ste. 100 City; Newport Beach
State:,CA I Zip Code: 92660 Agent Email Address:
Escrow company: Greater LA Escrow / Andrea Kawawaki Escrow #: 23593 -AK
EscrowAddress: 15315 Magnolia Blvd., Ste. 423 City: Sherman Oaks
State: CA zip Code 91403 Escrow Phone: 818-643-3222
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Email Report to: andrea@greaterlaescrow.com
For inspection call (Name): i Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED &.DATED BELOW)
a'utho"rize insilections and re -inspections of theproperty listed above. I understand that if Building or Zoni ng
violations are discovered a'. will be responsible to correct said violations.
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owner/Agent's signature to authorize inspection: '`-¢" i--"°-' I i
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owner/Agent's signatureto decline inspection:, ' Date:
141
Account # 01050504-521040 ................. Make checks payable to: CITY OF NEWPORT BEACH
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