HomeMy WebLinkAboutR2023-0467 - Permit ApplicationDocuSign Envelope lD-CA1C823D-CF2B-4833-BA8C-5D9D3C77072C
Print Form City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT CO&J BY
BUILDING DIVISION DEVELOPMENT
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100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658Y(
Rasta 22oZ3 octce� 53Y2023
� www.newportbeachca.gov � (g4g) 644-3200
Application for Report of CITY
Residential Building RecorAWPO ORBS Anolicati�_ $202.00 BEACH
(For All Residential Buildings)
Reinspection Fee $134.00
Notice:
Applications with insufficient fee payment
or incomplete will be returned
Please type or Drint and com fete all information
It of Units: I Address:l 40 A e 9nE
City: Newport Beach State: Zip: 92657
PropertyOwner. Erin Liberto, liberto living trust -
Zip Code: 92663
Owner Address: 453 Tustin Ave - ___'
City: Newport Beach
State: CA Zip Code: 92663
Home Phone: 949-326-3103
Owner's Authorized Agent: Jim Chiuminatta
Work Phone: 949-293-2291
Agentaddress: 26381 Crown Valley Parkwa Suite 150 -----
Y city: Mission Viejo
State: CA Zip Code: 92691 _
Agent Email Address: Chiuminattaa cox.net
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Escrow Company: Comer E111z,
Escrow #: 05-16332-ET
Escrow Address. 28202 Cabot Road 8uae 120
City: Laguna Niguel
state: F CA Zip Code:
92677 Escrow Phone:
Email Report to: eddie@cornerescrow.com 94g-325-3003
For Inspection call (Name): N/A
Direct Phone: I N/A
CONSENT 70 INSPECT FORM MUST BE SIGNED & DATED BELOW
I authorize inspections and re -inspections of the property listed above. I understand that if Building or Zoning
violations are discovered 1 will be responsible to correct said violations.
Owner/Agent's signature to authorize inspection:
Date: 5/30/2023
OR
Owner/Agent's signature to decline 11�a=u6190 by:
Date:
791AMj?pA74ED_.
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Account # 01050504-521040.................Make checks payable to: CrrrOFNEWPORTBEACH
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