HomeMy WebLinkAboutR2020-0800 - Permit ApplicationCity of Newport Beach p"09 Wa10,eqt �
COMMUNITY DEVELOPMENT DEPARTMENT �k
BUILDING DIVISION 1N�fda so
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915 p 1=
www.newportbeachca.gov 1 (949) 644-3200
RBR# QO-ZO- 0XWq3S
Application for Report of Residential Building Reco'i
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: -2— Address:424 Fernleaf Ave City: Newport Beach ( Corona Del Mar Area ) State: CA Zip: 92625
Property Owner: Troy M. Reyna and Pamela A. Reyna
Owner Address: - City:
State: -Zip Code: - Home
Owner's Authorized Agent: Casey Lesher Work Phone:
Agent Address: 840 Newport Center Dr. #100, City: Newport Beach State: CA Zip Code: 92660
Mobil Phone: _ Agent Email Address: caseylesher cimail.com
Escrow Company: Mariners Escrow Escrow # 59231 -DJ
Escrow Address: 270 Newport Center Drive, Suite 200
State: CA Zip Code: 92660
Email Report To: djohnson@marinersescrow.com
For Inspection Call (Name):
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:
OR �4 , l�
Owner or Agent's signature to decline inspection JJJDate: l i J ci
Account # 2900-5005............`....I.Make checks payable to CITY OF NEWPORT BEACH
_M IAN 1 VANS e J L"W ' C l�