HomeMy WebLinkAboutR2020-0839 - Permit ApplicationCity of Newport Beach P�cEivFO
COMMUNITY DEVELOPMENT DEPARTMENT er
BUILDING DIVISION COMMUNITY
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-Q915
www.newportbeachca.gov 1 (949) 644-3200 �EP 2 4 RECD
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Application for Report of Residential Building Retprds�PM�" Pdt
NFWPORS '-�V
Application Fee: $194.00 Notice: Applications with insufficient fee
payment
Reinspection Fee $ 129.00 or incomplete will be returned
Please type or print and complete all information
# of Units: -1— Address:1815 Santiago Drive City: Newport Beach State: CA Zip: 92660
Property Owner: 2009 Miller Family Trust as the sole and separate property of Daryl J Miller, as to an undivided one-half
interest and Craig J. Miller
Owner Address: - City:
State: -Zip Code: - Home
Owner's Authorized Agent: Grant Bixby Work Phone:
Agent Address: 341 Bayside Drive. City: Newport Beach State: CA Zip Code: 92660
Mobil Phone: - Agent Email Address: grantCfbixbyresidential.com
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 # 59305 -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
Owner or Agent's signature to decline
Account # 2900-5005 ................. Make checks payable to CITY OF NEWPORT BEACH
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