HomeMy WebLinkAboutR2020-0907 - Permit ApplicationDocuSign Envelope ID: 90D7F2DC-3F80-4E39-B50C-D807EDlCBAD3 OED
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City of Newport Beach 4a n�u'viry
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION (('�� Z�2d
p 100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA926588915
RBR# www.newportbeachca.gov (949) 644-3200
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#of Units: Address. 2391 azure Avenue City: Newport Beach State: CA :Zip 92660
PropertyOwner: David Childs
Zip Code: 92660
Owner Address: 285s Pinecreek Drive, C321[ Clty: Costa Mesa
State CA Zip Code: 92626 Home Phone 1661) 993-5526
Email Report to:� kedmiston@glenoaksescrow.com
For Inspection call (Name): David ehilas Direct Phone (661) 993-5526
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 orZoning
violationsare discovered lwillbe responsible to correct said violations.
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Owner/Agent's signature to authorize inspection: Date: 10/19/2020
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Owner/Agent's signature to decline inspection: Date:
Account # 01050504-521040 .................Make checks payable to: CITY OFNEWPORTBEACH
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