HomeMy WebLinkAboutR2023-0423 - Permit ApplicationRECEIVED
COMMUNITTYY
Print Fom1 City Of Newport Beach DEVELOPMENT
COMMUNITY DEVELOPMENT DEPARTMENT MAY 1
BUILDING DIVISION 5 2023
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 9265E-8915
-xim 42-02-3 -0AL3 www newpo Tbeachca gov � (949) 644-3200 CITY OF
NEWPORT BEACH
plication for Report of Residential Building Records
Application Fee: - $202.00
(For AIIResidential Buildings)
Reinspection Fee $134.00
Notice:
Applications with insufficient fee payment
or incomplete will be returned
Please type or print and complete all information
a of Units: F—Address: 21 Clermont
Property Owner:I Ronald Hill and Natalia Hill
Owner Address: 5 Landport
State: �— Zip Code: F92660
City: Newport Beach State: CA Zip: 92657
Zip Code:
City: I Newport Beach
Home Phone: 1 562-682-7065 1 562-644-3604
Owner's Authorized Agent: I Kaylyn Floryan Work Phone: 1949-326-3398
Agent Address: 22521 Avenida Empresa #102 City: Rancho Santa Margarita
State: r CA Zip Code: 92688 Agent Email Address: kaylyn@Floryanrealestate.com
Escrow Company: I platinum One Escrow
Escrow a: 1 015690-SA
Escrow Address: 122521 Avenida Empresa #102 City: I Rancho Santa Margarita
State: FA Zip Code: F92688 Escrow Phone: 833-7094018
Email Report to: Shannon@platinumorvneescrow.com II..,Dorine@platinumoneescrow.com,
For Inspection call (Name): Na-�, II (iL 11 I I Direct Phone: 5 (y^. L U(44 ?5
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 orZoning
violations are discovered Iwill beresponsible tocor ctsaidviolations.
Owner/Agent's signature to authorize inspection: Date: N 4 L�
OR
Owner/Agent's signature to decline
Account a 01050504 521040 .................Make checks payable to: CITY OF NEWPORT BEACH