HomeMy WebLinkAboutR2021-0615 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 9266818940
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Application for Report of Residential Buildin�k6cor s�
Application Fee: $198.00 Notice: Applicat ons with insufficient fee
payment
Reinspection Fee $ 131.00 or incomR&e will be returned
Please type or print and complete all information
# of Units: 1 Address:424 Fernleaf Avenue, Unit A City: Newport Beach ( Corona Del Mar Area ) State:
CA Zip: 92625
Property Owner: Bire II, LLC, an Illinois Limited Liability Company and Eire II, LLC, an Illinois Limited Liability Company
Owner Address: - City:
State: -Zip Code: - Home
Owner's Authorized Agent: Timothy Tamura Work Phone:
Agent Address: 2720 E. Coast Highway, City: Corona Del Mar State: CA Zip Code: 92625
Mobil Phone: - Agent Email Address: tim(o)valiaoc.com
Escrow Company: Mariners Escrow Escrow # 61358 -BF
Escrow Address: 270 Newport Center Drive, Suite 200 City: Newport Beach
State: CA Zip Code: 92660 Escrow Phone: 949-640-6040
Email Report To: I3CGRSFAr,0MiRRI!VeR$eSCteOW•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 or Agent's signature to authorize inspection
R
Owner or Agent's signature to decline inspection Date: cLQ a I
Account # 2900-5005 ................. Make checks payable to CITY OF NEWPORT BEACH