HomeMy WebLinkAboutR2021-0032 - Permit Application (3)DocuSign Envelope ID: 57C9C20D-DC73-4E24-94D8-BF826BBFD92F
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Print Form City of Newport Beach 'i:OMMUNII
COMMUNITY DEVELOPMENT DEPARTMENT ''N'rt_I i"IrMer'
BUILDING DIVISION
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100 Civic Center Drive I P.O. Box 1768 I Newport Beach, CA926S -8 1�
RBRtf 'I y www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Recprds
Application Fee: - $194.00 Notice:
(For AIIResidential Buildings) Applications with insufficient fee payment
Reinspection Fee $129.00 or incomplete will be returned
Please type or print and complete all information
# of Units: I— Address: 2392 Redlands Dr City; Newport Beach State: r"' Zip:F 92660
Property owner: Nasser Bazarehi & Maryam Sahihi Zip code: F 92627
Owner Address: 2401 Narbonne Way city: Fcosta Mesa
State: CA, Zip Code: 92627 Home Phone:
Owner's Authorized Agent: Michelle Nugyen
Work Phone: I 714-781-9621
Agent Address: 4425 Jamboree Rd City:
NewporiBeach
State: Ca zip code: 92660 Agent Email Address:
michelle.luxuryrealestate@gmail.com
Escrow Company: Central Escrow Group, Inc
Escrow #: CEG606166-CM
Escrow Address: 20 Corporate Park Suite #185 city:
Irvine _
State: Ca , Zip Code: F 92606
Escrow Phone: 949-333-8788
Email Report to: ming.ci@centralescrowgroup.com
For Inspection call (Name): Ming CI
Direct Phone: �—
CONSENT TO INSPECT (FORM MUST BE SIGNED
& DATED BELOWI
I 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 correct said violations.
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Owner/Agent's signature to authorize inspection: ��ayAYf�, i�bSSLV' Date: 1/11/2021
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OR
Owner/Agent's signature to decline inspection:
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Date:
Account It 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH