HomeMy WebLinkAboutR2020-0933 - Permit ApplicationDocuSign Envelope ID: E40698FC-393A-4A84-ACOS-3B5322BF0715 -
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Print For City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT COMMUNITY
BUILDING DIVISION nnIInn tf
��77,,�� 100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA92658Y891`S2
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RBR# XJ www.newportbeachca.gov 1 (949) 644-3200
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Application for Report of Residential Building Rec, ds 10
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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 information
#of Units: - Address: 2007 Yacht Vigilant - City Newport Beach ` State: CA Zip: 92660
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Property Owner. ThomasLoucks
Zip Code:.
owner Address: 2007 Yacht Vigilant city: Newport Beach
State: CA Zip Code192660 Home Phone: 71 4 432-7066
Owner's Authorized Agent: Adam Loucks Work Phone: 949-439-1681 ..
Agent Address: S 56 S. Mission Rd#703-711 City: Bonsall
State: CA Zip Code 92003 Agent Email Address: ealtoradaniloucks@gmail.com
Escrow Company: California Sunset Escrow Escrow#: 22 2202440
Escrow Address: 17330 Newhope St. ,Suite D City: Fountain Valley
State: U Zip Code 92708 Escrow Phone: 714-432-7066
Email Report to: I Karan@californiasunsetescrow.com
For Inspection call (Name): Karen Stout Direct Phone: 714-432-7066
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
�Dto:gn�dby: 10/29/2020
owner/Agent's signature to decline inspection: I ILdexn M.VGf Date:
Account # 01050504-521040 ................. Make checks payable to: CITY of NEWPURI MAUI
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