HomeMy WebLinkAboutR2020-0810 - Permit ApplicationDocuSign Envelope ID: 40444C81-C788-47A5-8021-145DF181 E1 DA
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City of Newport Beach 49j,
COMMUNITY DEVELOPMENT DEPARTMENT COMMUNITY
BUILDING DIVISION GG pp
f 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658'991A 7 RECD
RBR# � 10 3- OK 1 G www.newportbeachca.gov 1 (949) 644-3200
On DEVELOPMENT G,Z,
Application for Report of Residential Building Recolros �P
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Application Fee: -..$191.00 Notice: - f
(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 information
#ofUnits: Address: 430 Catalina Drive
City: Newport Beach.' State: CA !Zip: 92663,.
Property Owner: Mike and Mary Nash Zip Code: F',,
Owner Address: - City:
.
State: CA._. Zip Code F Home Phone: .. _. _... ...._...
Owner's Authorized
Agent:
Tim
Carr
Work Phone:
949, 631.9999
Agent Address:
450 Newport
Center
Drive,' Suite 100
City:
NB, CA 92660
State: F Zip Code: F Agent Email Address: tci@timcarrgroup.com
Email Report to: I bfoxcroft@marinersescrow.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. I understand that if Building or Zoning
violations are discovered I will be responsible to correct said violations.
Owner/Agent's signature to authorize inspection: Date:
OR
Owner/Agent's signature to decline inspection: k&.0 wiaras o
.w�..." Date: 9/17/2020 1 12:22 PM PDT
.... _. ...._..
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
Bulldin�Division\Forms\RBR_9-18-18