HomeMy WebLinkAboutR2020-0302 - Permit Application-G,E.IV@p ay
' Print Form City of Newport Beach ��--
0010 MUNITY
COMMUNITY DEVELOPMENT DEPARTMENT OIVELOPMENl
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA926 93% 2020
RBR# ��OZ-Q— www.newportbeachca.gov 1 (949) 644-3200
Annlication for Renort of Residential Building Record- riYOF
Application Fee: - $191.00Wl-'ORT
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Notice:
(For All Residential 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: 5 San Martin Way City: Newport Beach State: CA ''Zip: 92625
Property Owner:I Walter Dennis Renter Zip Code: F625
Owner Address: 5 San Martin Way City: Newport Beach
State: CA Zip Code: 92625 Home Phone: 949.640.8226
Owner's Authorized Agent: Mackenzie and Cannon Work Phone: 949.278.2379
I
Agent Address: 16833 Quail Hill Pkwy City: Irvine
State: CA Zip Code: P2603 _ Agent Email Address; mac@macteam.com
Escrow Company: lWest Coast Escrow Escrow#:I 4530220-02353
Escrow Address: 6833 Quail Hill Parkway City: Irvine
State: CA ---- Zip Code: 92603 Escrow Phone: 949.854.7353
Email Report to: nicole.matte son@wes tcoa s to s crow. com .
For Inspection call (Name): Direct Phone:
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 inspection! --' --.
Date:
Date: l
Account $102050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
Building Dl visinrvornos\RBP 9-18-18