HomeMy WebLinkAboutR2020-0868 - Permit ApplicationPirtrit Fqtmm City of Newport Beach ",�,,,C)OVEL)
COMMUNITY DEVELOPMENT DEPARTMENT 00MtfikAlTy
BUILDING DIVISION iD[-VFI_QP1v1FNT
100 Civic Center Drive I P,O, Box 176,8 1 Newport Beach, CA92656C111 zon
RSR41 www,newportlaeachca.gov 1 (949),644-3200
Application for Report of Residential Building Recordsoi r", OF
Apolication Fee: $194.00 Notice: tai-vd<'
(For All Residential Buildings) Applications with Insufficient fee payment
Reinspection Fee $ 129.00 or Incomplete will be returned
Please type or print andcomplete all Information
# of Units: Address: %32 4 7ORT`SIML GIRL, City-' Newport State: FA ZIP.
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Pi-opertyOwner:FW/.?Rx—Ei�z—uuUI4ei- Zip Code: F_5_z(;rc co
Owner Address:1ROZ-1 3F_>iS7ZDL Cl ECLS City: F Hi�_UJFO-RT
State: [CA Zip Code: [�2 GO Horne Phone:
�Owner's Authorized Agent; [ Mina M agha ml and Joseph M agh a mi Week Phone: 49-874-4020 and 949-811619
Agent Address! Pacific Sotheby's International Realty city: Newport Beach
State: ["CA Zip Code: � 92660 Agent Email Address: mnannagharniftmall.corn and kjmagha6ggmaiI.c0n1
Escrow Company: TzsceaAj
Escrow Address: "BiLu ... Z- "16,DCitv:
State! I C -Al Zip Code:[ 9aa 12-
Escrow#d t�8_ 5coz_vpz
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,Escrow Phone: F9
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Email Report to; oL--4 j< D pjaCG, 04 P-0' e Q MAL - 66M
For Inspection call (Name): Mina 1 Magharni or Joseph Magharni Direct Phone: W-874.4020 arA 940$131619
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CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
I authorize inspections and re-inspectlons-of the -property listed above -I undE
violations are discovered I Will be responsible to correct said violations.
DocuSigned by:
Owner/Agent's signature to authorize inspection: F% Zk,
OR
Owner/Agent's-signature to decline inspection:
Data: F10 7_2_`_0
Date: F
Account # 01050504-521040___ ........ Make checks payable to: OTY OF NEWPORT BEACH