HomeMy WebLinkAboutR2022-0379 - PermitsDocuSign Envelope ID: 4FE46D7C-OOEA-4111-A9E6-DC7B3E32981D
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:z nritF rm City of Newport Beach Jtvt4rIpNITY
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION 'UL 2 6 2022
N/A 100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA92658-8915
RBR#www.newportbeachca.gov (949)644-3200 CITYOFe
Application for Report of Residential Building RecorcTgop-r BeP°r
Application Fee: - $202.00 Notice:
(For All Residential Buildings) Applications with insufficient fee payment
Reinspection Fee $134.00 or incomplete will be returned
Please type or print and complete all information
#ofUnits: Address: 504 Playa _ City: Newport Beach State: 'Zip: 2660
Property Owner: Wliiiam Campoy Zip Code: 90210
Owner Address: 1366 Angelo Drive City: Beverly Rills
90210 310-383-2732
State: CA Zip Code: Home Phone:
Owner's Authorized Agent: N/A Work Phone: N/A
Agent Address: N/A City: N/A
State: N/A Zip Code: N/A _ Agent Email Address: N/A
Escrow Company: Glen Oaks Escrow Escrow #: 48673-MK '..
13949 Ventura Blvd. #320 Sherman oa s
Escrow Address: City:
State: CA - Zip Code: 91423 Escrow Phone: 18-500-0400
Email Report to: mkline@glenoaksescrow.com
For Inspection call (Name): willam_Campoy Direct Phone: 310-383-2732
__
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.
LDocuOW
ftned by��:
Owner/Agent's signature to authorize inspection: M I__�pe� INSPEQ1')
OR Doeusleueaby:DECLINED
Owner/Agent's signature to decline FWI�IA�1t (Amm Date: 7/21/2022
111 en®ra�nennaanas
Account # 01050504-521040 .................Make checks payable to: CITY OFNEWPORT BEACH
Building BNlslon\Farms\RRR_6-15-22