HomeMy WebLinkAboutR2023-0471 - Permit ApplicationPrint Form
City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
100 Civic Center Drive 1 P.O. BUILDING
7BDIVISION port Beach, CA 92658-8915
(�2023 � py-11
www.newportbeachca.gov 1 (949) 644-3200
Aoe• -
olication Fee: $202.00
(For All Residential Buildings)
Reinspection Fee $134.00
for Report of Residential Building Records
RECEIVED By
COMMUNITY
DEVELOPMENT
MAY 312023
CITY OF
NEWPORT BEACH
Notice:
Applications with insufficient fee payment
or incomplete will be returned
Please type or print and complete all information
# 01 Units: Address: 1524 CanCha
City: Newport Beach State: Zip: 92660
Property owner: The Daniel C. Haight & Mari Ann Meek Haight Living Trust
Owner Address:
State: F�
Owner's Authorized Agent:
Agent Address:
--F
State: l F
Zip Code: F—
Zip Code: F —
City
Home Phone:
Work Phone: I
City:
Agent Email Address:
Escrow company: Freedom Escrow
Escrow Address: 1200 Newport Center Dr., Suite 180
State: CA Zip Code: 92660
Email Report to: I mm@freedomescrow.com
For Inspection call (Name): F N/A
Zip Code: r�
Escrow #: 1055842-MM
City: I Newport Beach
Escrow Phone: I (949) 644-3939
Direct Phone:
CONSENT TO INSPECT FORM MUST BE SIGNED & DATED BELOW
I authorize inspections and re -inspections of the grope violationsarediscovered lwillberesponsible toCorrect said violations. I understand thatif BuildingorZoning
Owner/Agent's signature to authorize inspection:
Date:
OR
Owner/Agent's signature to decline
17 Dater
6d&22
OS.3a.`�
Account # 01050504-521040 .................Make checks payable to: C/TYOF NEWPORT BEACH
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