HomeMy WebLinkAboutR2023-0452 - Permit ApplicationDocuSign Envelope ID: OE3D7890-64A5-4A71-BF51-D25E0108CFA1
Print Form City of Newport Beach COMEIVEDBY
COMMUNITY DEVELOPMENT DEPARTMENT DEVELOPMENT
BUILDING DIVISION s�ppyy Z�23
100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA92658= Aj
R9U# Q2023 — 0`t 5 Z www.newportbeachca.gov (949) 644-3200 CITY of
NEWPORT BEACH
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: F [Newport Address: 17 Muir Beach Circle City: Beach State: CA Zip: 92625
Propertyowner: Hugo F. Aviles and Irene Aviles Zip code:
Owner Address: 134 Deep Sea city: I Newport Coast
State: CA Zip Code: IF57T57 Home Phone:
(949)433-0111
Owner's Authorized Agent: I Wind Water, Inc. work Phone: I (949)679-5999
Agent Address: 119762 MacArthur Blvd Ste 100 city: Irvine
State: FCA Zip Code: 92612 Agent Email Address: JNOEL@WINDWATER.COM
Escrow Company: I Fidelity National Title Escrow #:I 393512-TL
Escrow Address: 1300 Dove Street Ste 300 City: Newport Beach
State: F CA zip Code: 92660 Escrow Phone: (949) 788-2836
Email Report to: TLE@FNF.COM
For Inspection call (Name): I Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
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 correctsaid violations.
Owner/Agent's signature to authorize inspection: Date:I
Dew/r''gy��lpp d by:
Owner/Agent's signature to decline Date: 5/23/2023
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Account # 01050504-521040 .................Make checks payable to: CITY OFNEWPORT BEACH
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