HomeMy WebLinkAboutR2023-0313 - Permit Applicationuocu�Pflnt Form iu�ir�oroiuw-vetr-rs�nu-rua�aa��City of Newport Beach Ofl�4r
COMMUNITY DEVELOPMENT DEPARTMENT M
BUILDING DIVISION I 72023
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915 C
FAM# 1Z207-3 03�.?>' www.newportbeachca.gov 1 (949) 644-3200 NE�OF
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Application for Report of Residential Building Records
Application Fee: - $202.00 Notice:
(For AIIResidential Buildings) Applications with insufficient fee payment
Reinspection Fee $134.00 or incomplete will be returned
Please type or print and complete all information
# of Units: 1 —1 Address: F2283 La Linda Ct
PropertyOwner:l John Dixon and Lisa Blackledge
Owner Address: I 2283 La Linda Ct
State: CA Zip Code: F92660
Owner's Authorized Agent: I Spencer Wall
City: Newport Beach State: I"" Zip: 92660
Zip Code: F92660
City: Newport Beach
Agent Address: 132356 S. Coast Hwy City:
State: CA Zip Code: r92651 Agent Email Address:
Escrow Company: I Corner Escrow
Escrow Address: 31706 Pacific Coast Hwy. Suite #302 City:
State: CA Zip Code: F92651
Email Report to: I spencer@wallrealtygroup.com
For Inspection call (Name): I Spencer wall
Home Phone: 1 213 304 8034
Work Phone: 1949 375 7768
Laguna Beach
Spencer@wallrealtygroup.com
Escrow #: I N/A
Laguna Beach
Escrow Phone: 1 949 236 4357
Direct Phone: 1 949-375-7768
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
I authorize inspections and re -inspections of the property listed above.I understandthat if Building or Zoning
violations are discovered I will be responsible to correct said violations.
Owner/Agent's signature to authorize inspection: Date:
OR
DocuSgned by:
Owner/Agent's signature to decline � 0.,e Date: 4/17/2023
C1S5FHKF8DEr468_.
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
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