HomeMy WebLinkAboutR2021-0396 - Permit ApplicationCi'(of Newport Beach���lul � .
COMMUNITY DEVELOPMENT DEPARTMENTc0Mt4UN!)'y=
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BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915 MAy 2 G ?�4y
www.newportbeachca.gov 1 (949) 644-3200
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Application for Report of Residential Building Records ��kpotrr aECG6
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:—l— Address:419 Iris Avenue City: Newport Beach r Corona Del Mar Areal State: CA Zip: 92625
Property Owner: Ocean Surf Trust dated March 4th 2012
Owner Address: - City:
State: -Zip Code:- Home
Owner's Authorized Agent: Jesse Barraza Work Phone:
Agent Address: 1400 Newport Center Drive, Suite 100, City: Newport Beach
State:
CA
Zip Code: 92660
Mobil Phone: (714) 292-2497 Agent Email Address: ibarraza(casurterreproperties
com
Escrow Company: Mariners Escrow
Escrow Address: 270 Newport Center Drive, Suite 200
State: CA Zip Code: 92660
Email ReportTo: rbuenrostro@marinersescrow.com
For Inspection Call (Name):
Escrow # 60823 -RB
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.
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Owner or Agent's signature to authorize inspection '"I allt 14k. W Date: S� Z`( ?
t
OR
Owner or Agent's signature to decline inspection Dat
Account # 2900-5005 ................. Make checks payable to CITY OF NEWPORT BEACH