HomeMy WebLinkAboutR2021-0614 - Permit Application- City of Newport Beach
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COMMUNITY DEVELOPMENT DEPARTMENT b y
BUILDING DIVISION coMMur fly
100 Civic Center Drive I P.O. Box 17681 Newport Beach, CAc921958*15
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www.newportbeachca.gov 1 (949) 644-3200 AUC 2 a nZI
Application for Report of Residential Building 1146r°8s,
Application Fee: $198.00 Notice: Applications with insufficient fee
payment
Reinspection Fee $ 131.00 or incomplete will be returned
Please type or print and complete all information
# of Units: -1— Address:123 30th Street City: Newport Beach State: CA Zip: 92663
Property Owner: The Mary Anne Walsh Revocable Trust Dated 10-29-93
Owner Address: - City:
State: -Zip Code: _ Home Phone:
Owner's Authorized Agent: Laurie Eastman Work Phone:
Agent Address: 520 Newport Center Dr. Ste 330, City: Newport Beach State: CA Zip Code: 92660
Mobil Phone: - Agent Email Address: laurie.eastman(cacompass com
Escrow Company: Mariners Escrow Escrow # 61379 -BF
Escrow Address: 270 Newport Center Drive, Suite 200
State: CA Zip Code: 92660
Email Report To: bfoxcroft@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
OR
Owner or Agent's signature to decline inspection
Account # 2900-5005 ................. Make checks payNble to CITY OF NEWPORT BEACH