HomeMy WebLinkAboutR2020-0871 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT 1iEcpiVEn
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-806)44%M`rY
www.newportbeachca.gov 1 (949) 644-3200 oc
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Application for Report of Residential Building R c`6vf ls3,_ r
Application Fee: $194.00 Notice: Applications w u `tient fee
payment
Reinspection Fee $ 129.00 or incomplete will be returned
Please type or print and complete all information
# of Units: -1— Address:22 Via Amanti City: Newport Beach ( Newport Coast Area ) State: CA Zip: 92657
Property Owner: Karen Worthington Petillo Trust
Owner Address: _ City:
State: -Zip Code: _ Home Phone:
Owner's Authorized Agent: _ _ Work Phone:
Agent Address: , City: _ State: CA Zip Code:
Mobil Phone: _ Agent Email Address:
Escrow Company: Mariners Escrow
Escrow Address: 270 Newport Center Drive, Suite 200
State: CA Zip Code: 92660
Email Report To: djohnson@marinersescrow.com
For Inspection Call (Name):
Escrow # 59367 -DJ
City: Newport Beach
Escrow Phone: 949-640-6040
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 or Agent's signature to authorize inspection Date:
R fi 1
Owner or Agent's signature to decline inspectio ate: C '
Account # 2900-5005 ................. Make checks payable to CITY OF NEWPORT BEACH
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