HomeMy WebLinkAboutR2022-0194 - Permit Application"u,t`1 m City of Newport BeachCOVED a),
COMMUNITY DEVELOPMENT DEPARTMENT COMMUNITY
BUILDING DIVISION DEVELOPMENT
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92pp§-19J52022
RBR# I�Z� www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Recordi3TYOF
Application Fee: - $198.00 Notice: 4 4VPORT BEPG
(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: 1 Terraza Drive city: Newport, Beach State: CA Zip: 92657,_
Property Owner: Malcolm A. Schneer Zip Code:
Owner Address: 13505 Cadillac Ave J-1 city: Costa Mesa
State: CA Zip Code: F92626 Home Phone
Owner's Authorized Agent: Nancy Perez Work Phone: 714-250-4004
Agent Address: 4 First American Way city: Santa Ana
State: FE7A Zip Code: 92707 ! Agent Email Address: teamnancy@flrstam.com
Escrow company: First American Title Company I Escrow #: OSA-6809322
Escrow Address: 4 First American Way City: Santa Ana j
— -.
State: Cq Zip Code: 92707 Escrow Phone: 714-250-8191
Email Report to: teamnancy@firstam.COm
For Inspection call (Name): Nancy Perez Direct Phone: 1 714-250-4004 l
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
I authorize inspections and re -inspections of the property listed above. l understand that if Building or Zoning_
violations are discovered l will be responsible to correct said violations.
Owner/Agent's signature to authorize inspection: INSPECTION Date:
MCLINLD
OR
Owner/Agent's signature to decline inspection: ✓T�1�✓�s � � Date: 4-7-2022
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
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