HomeMy WebLinkAboutR2021-0185 - Permit ApplicationA s'
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PpntForm City of Newport Beach �COMM�NITY
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION MAR ..1 p 202i
�� 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
RBR# b www.newportbeachca.gov 1 (949) 644-3200 cll Y ojr
Application for Report of Residential Building RecdiiSQ, - c�
Application Fee: - $194.00 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 infarmation
# of units: T Address: 1 3515 Seashore Drive City:Newport Beach State: ICAZip: 92663
PropertyOwner: My House, LLC Zip Code: r91202
Owner address: 1 1025 N. Brand Blvd., Suite 230 Gtr rGiendale
State: I"' Zip Code: F91202 Home Phone: 818-547-2445
owner's Authorized Agent: Michael Markarian work Phone: 1 818-547-2445
Agent Address: 1025 N. Brand Blvd., Suite 230 City: FGlendale
State: FCA Zip Code:91202 Agent Email Address: michael@mb3consult.com
Escrow Company: I Chartwell Escrow, Inc. Escrow #: I CWPC-VP-453
Escrow Address: 680 E. Colorado Blvd., Suite 160 City: Pasadena
State: FEA Zip Code: 91101 Escrow Phone: 626-940-3380
Email Report to:Fvperez@chartwellescrow.com
For Inspection call (Name): Direct Phone:
I authorize inspections and re -inspections of the property listed above. I understand that if Building or Zoning
violations are discovered lwill beresponsible tocorre saidv lations.
Owner/Agent's signature to authorize inspection: Date: 130, 0U
1
OR
Owner/Agent's signature to decline Inspection:
Bu WI�dNYon\ramu\NBI�13d30
Date: I
Account # 01050504-521040 .................Make checks payable to: CITV OF NEWPORT BEACH