HomeMy WebLinkAboutR2021-0716 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT : Vic( NvEu ;
BUILDING DIVISION aOMKP..uniiTY
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8J'16-`P',1Errr
www.newportbeachca.gov 1 (949) 644-3200 0C1 06 2021
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Application for Report of Residential Building Record'' "`
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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:1441 Sandcastle Drive City: Newport Beach ( Corona Del Mar Area ) State: CA Zip:
92625
Property Owner: The Cooper Living Trust dated December 3 2004
Owner Address: - City:
State: -Zip Code: _ Home
Owner's Authorized Agent: Jody Chapman Work Phone: (949) 689-8594
Agent Address: 520 Newport Center Dr Ste 330, City: Newport Beach State: CA
Mobil Phone: - Agent Email Address: iody@c_haomanREgrgij com
Escrow Company: Mariners Escrow
Escrow Address: 270 Newport Center Drive Suite 200
State: CA Zip Code: 92660
Email Report To: rbuenrostro@marinersescrow.com
For Inspection Call (Name):
Escrow # 61652-RB
City: Newport Beach
Escrow Phone: 949-640-6040
Zip Code: 92660
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
IM
Owner or Agent's signature to decline inspection
Account # 2900-5005- ...............Make checks payable to CITY OF NEWPORT BEACH