HomeMy WebLinkAboutR2021-0717 - Permit ApplicationQocil Sign Envelope ID: 19CB5CFF-C71 E-45BA-9E70-5716F226A806
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PdntFbrm - City of Newport Beach OCT 6 7 2021
COMMUNITY DEVELOPMENT DEPARTMENT
�n BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA92658-8915 CY
RBRH Y` VU/� ` www.newportbeachca.gov (949) 644-3200 r?r,.•r,,`il:2p''
Appucation for Report of Residential Building Records
Application Fee:-$194.00 Notice:
(For AIIResidential Buildings) Applications with insufficient fee payment
Reinspection Fee $129,00 or incomplete will be returned
Please type or print and complete all information
s of Units: FT -Address: 52 Sidney Bay Drive
Property owner:j Daniele Doimo
Owner Address: I 52 Sidney Bay Dr
State: F Zip Code: 92657
Owner's Authorized Agent: I Gary Boisen
Agent Address: I 540 S Coast Hwy, Suite 202
State: CA Zip Code: 92651
Escrow Company: I Corner Escrow
Escrow Address: 31706 S Coast Hwy, Suite 302
State: CA Zip Code: 92651
Email Report to: I donnas@cornerescrow.com
For Inspection call (Name): I N/A
City: Newport Beach State: CA Zip: 92657
Zip Code: F92657
City: I Newport Beach
Home Phone:1 949-537-1537
Work Phone: 1 949-274-2236
City' I Laguna Beach
Agent Email Address: I gary.boisen@compass.com
Escrow 40 07-9564-DS
City: I Laguna Beach
Escrow Phone: 1 949-313-7333
Direct Phone: 949-313-7333
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 Iwill be responsible to correct said violations.
Owner/Agent's signature to authorize inspection:
Date:
OR
aocualgnea by:
Owner/Agent's signatureto decline inspection: _ FV--,,t, VOtw16 Date: 10/6/2021
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Account ff 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
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