HomeMy WebLinkAboutR2021-0750 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENTy-
fl BUILDING DIVISION
�d 00 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-891S(T 2 fi ZOZi
tl` www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records `'TY"'
Application Fee: - $198.00 Notice: 4 '2 OR C v �
(For All Residential Buildings) ` Applications with insufficient fee payment
Reinspection Fee $;131.00 or incomplete will; be returned ,
Please type or print and complete all information
# of Units: Address: ree _.._ City: Newport Beach State: �Zip:FT
Propertyowner: E. Kurt Yeager and Barbara Koehler -Yeager Zip code:
Owner Address: 2330 E. 15th Street city; Newport Beach
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State: CA Zip Code. 92663 Home Phone:
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Escrow company: Pickford Escrow Company Escrow #: 17233-SG
Escrow address: 1400 Newport Center Dr #240 city: Newport Beach j
State: CA Zip Code 92660 Escrow Phone: 949-718-0604
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Email Report to: '
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For Inspection call (Name): __._ _._. __ �q,,,,,_, .� 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 ]will be responsible to correct said violations.
Owner/Agent's signature to authorize inspection: Date: �-
OR
Owner/Agent's signature to decline inspection: Date:
Account # 01050504-521040 ...... ........... Mak6checks payable to: CITY Of NEWPORT BEACH
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