HomeMy WebLinkAboutR2023-0730 - Permit Application_rm RECEIVED BY
Print FaCity of Newbeach COMMUNITY
DEVELOPMENT
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION AUG 0 9 2023
iT 100 Civic Center Drive I P.O. Box 1768 i Newport Beach, CA92658-8915
0 www.newportboachca.gov I (949) 644-3200 CITY OF
NEWPORT BEACH
$nr Rannrt of Residential Building Records
Application Fee: - $202.00 Notice:
(For Ali 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: 12527 Port Whitby City: (Newport Beach State: CA Zip: 92660
I92660
Propertyowner:I Yeganeh Abouhossein Zip Code:
Owner Address: 1 2527 Port Whitby City: I Newport Beach
State: ICA Zip Code: I 92660 Home Phone: 1949-813-1401
Owner's Authorized Agent: (Yeganeh Abouhossein work Phone: 949-813-1401
Agent Address: 14050 Barre nca Parkway, Suite 150 City: I Irvine
State: f-
Irvine Zip Code: 192604 Agent Email Address: yeggyrealtor@gmail.com
Escrow Company: I Comer Escrow
Escrow Address: (18600 MacArthur Blvd, #350
Stated -CA-
CA Zip Code: 192612
Email Report to: Idavid.ozuna@cornerescrow.com
For Inspection call (Name): ;Yeganeh Abouhossein
Escrow #: l 08-12008-DO
City: I Irvine
_ __ ......................
Escrow Phone: 1949-800-8908
Direct Phone: 1949-813-1401
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 or Zoning
violations are discovered I will be responsible to correct said violations.
Owner/Agent's signature to authorize inspection:
Owner/Agent's signature to decline
m
Date:
Date:
Bujjdi nmmcn\rnrm WR_6-15 33
Account It 01050504-521040 ..................Make checks payable to: CITY OF NEWPORT BEACH