HomeMy WebLinkAboutR2020-0922 - Permit ApplicationVEM
City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.Q. Box 17681 Newport Beach, CA92658-8915
RBR# M2C) " O� 22 www.n"portbeachea.gov 1 (949) 644-3200
Application for Report of Residential Building Records
Application Fee: - $194.00 Noticee
(For All Residential. Buildings) Applications with insufficient fee payment
iteinspection Fie$:129.00 or incomplete will be returned
Please type or print and complete all Information
# of Units: ❑ Address: 1209 Bav Hill Dr City: Newport Beach State: F1Zip: 92660
Property Owner: Tu Nguyen. ( Nin jou a
Zip Code:
Owner Address: 3248 Giant forest City: I Chino Hills
State: Zip Code: 1 4 Home Phone: 213-458-2671
Owner's Authorized Agent: I Me an Vara Work Phone:
Agent Address: 341 Bayside Dr City:
State: CA Zip Code: 2 60 Agent Email Address: Imegan.varga@compass.com
Escrow Company: Jae Esrow Inc I Escrow #: °�13—R..
Escrow Address: 1 9604 Las. Tunas Dr City:
State: Zip Code: ® Escrow Phone: 626-642-8889
EmailReportto: F kay@jadeescrcyw.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. l understand that if Building or Zoning
violations are discovered l will be responsible to correct said violations.
Owner/Agent's signature to authorize inspection
Owner/Agent's signatureto decline Inspection:
euftn aV m Vy \RBa_7aa:0
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH