HomeMy WebLinkAboutR2023-0371 - Permit Application (3)DocuSign Envelope ID: 460AC3A2-F804-49C5-9469-4D992544E591
Print Porn City of Newport Beach COMMUNITY
COMMUNITY DEVELOPMENT DEPARTMENT DEVELOPMENT
BUILDING DIVISION pp pppp
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-864 202023
•RBR# �ZOZ Zi - 0 3 Z zj www.newportbeachea.gov 1 (949) 644-3200
CITY OF
Application for Report of Residential Building Records NEWPORT BEACH
I
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
If of Units: Address: Cape An OveY City: Newport Beach State: Zip: 9 6
PropertyCwner. Justin PUrpero Zip Code: ---
Owner Address: 15 Cape Andover City: Newport Beach
State: I` Zip Code: 1 92660 dome Phone: 714-504-9730
Owner's Authorized Agent: Annie Clougherty Work Phone: 1 949-375-3037
Agent Address: 341 Bayside Drive City. Newport Beach
State:. CA Zip Code: 92610 Agent Email Address: annle.0 OUg er y CO mpaSs.CCm
Escrow company: I First American Title
Escrow Address: 4 First American Way City:
State: I CA Zip Code: F92707
Email Report to: annie.clougherty@compass.com
For Inspection call (Name): I Annie Clougherty.
Escrow#:IOSA 6968277
Santa Ana
Escrow Phone:
Direct Phone: 949-375-3037
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
I authorize inspections and re -inspections ofthe property listed above. I understand that if Building or Zoning
violations are discovered I wil I be responsible to correct said violations.
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Owner/Agent's signature to authorize inspection: o(JeiuPri Date:
OR
..
Owner/Agent's signature to decline Date: F-
Account # 01050504-521040.................Make checks payable to: Li r r ur Ivcwvuxr nrru.n
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