HomeMy WebLinkAboutR2023-0395 - Permit ApplicationRECEIVED BY
Print Form City of Newport Beach COMMUNITY
DEVELOPMENT
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION MAY 0 9 2023
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
�.L02 3 d39 rj www.newportbeachca.gov 1 (949) 644-3200 CITY OF
NEWPORT BEACH
A..nfientinn fnr RPnnrt of Residential Building Records
Application Fee- - $202,011 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
# of Units: I ' Address: 63 Mandria City Newport Beach State: CA zip: 92657
Propertyowner: Harry Layman Zip Code: F—
Owner Address: City:
State: I—' Zip Code: �— Home Phone:
Owner's Authorized Agent: Work Phone:
Agent Address: City:
State: F— Zip Code: �— Agent Email Address:
Escrow Company: Freedom Escrow Escrow#: 055813-MM
Escrow Address: 1200 Newport Center Dr., Suite 180 CityNewport Beach
state: CA Zip code: F92660 Escrow Phone: (949) 644-3939
Email Report to: mm@freedomescrow.COm
For Inspection call (Name): N/A Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
Fthorize inspections and re -inspections of the property listed above. I understand that if Building or Zoning
ations are discovered Iwill be responsible to correct said violations.
ner/Agent's signature to authorize inspection: Date:
OR
Owner/Agent's signature to decline � iil�� 1/jliv}/fi��Jct? Date: Cjs-a`j-Z 3
Account # 01050504-521040.................Make checks payable to: CITY OFNEWPORT BEACH
Building Division\Forms\RM 615-22