HomeMy WebLinkAboutR2023-0177 - Permit ApplicationPrint Form;
City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT RECEIVED BY
BUILDING DIVISION COMMUNITY
100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA92658-8916EVELOPMENT
t+allu- 2Z DZ 3 'D 1-7-7 www.newportbeachca.gov ( (949) 644-3200
MAR 0 2 2023
Application Tor Report oT Kesidential Building Records
Aoolication Fee: - $202.00 Notice: NEWPORT BEACH
(For Alt Residential Buildings) Applications with Insufficient fee payment
Reinspection Fee $134.00 or incomplete will be returned
Please type or print and complete all information
It of units: ( 1 Address: 1 2101 East 15th St. #15 City: Newport Beach state: FCA Z11P:j 92663
Property owner. Matthew and Amanda D'Abusco Zip code: 92663
Owner Address: 12101 East 15th St. #15 City; Newport Beach
State: ICA — Zip Code: F 92663 Home Phone: I
Owner's Authorized Agent: Work Phone: I —
Agent Address: I City:
State: F — Zip Code: �_ Agent Email Address:
Escrow Company: Concord Escrow Escrow #: 1 23-0061-SC
Escrow Address: 22031 Bushard Street city: FHuntington Beach
State: CA Zip Code: F92646 Escrow Phone: 1 714-965-3616
EmailReportto:, samantha@concordescrow.Com
For Inspection call (Name): ( 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 1 will be responsibleto correct said violations.
Owner/Agent's signature to authorize inspection: Date:F �
OR �/�J
Owner/Agent's signature to decline M��--- A �/U�
— Datea 3/2/2�3
r+ccount a U1U5U5U4-521040 .................Make checks payable to: CITY OF NEWPORT 8EACM
Bwltling,plWYoo\fmtyytpp $�SS-22