HomeMy WebLinkAboutR2023-0181 - Permit ApplicationRECEIVED By
1 �^���4�� DEVELOPMENT
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Pnnt Form, ,r � City of Newport Beach MAR 0
COMMUNITY DEVELOPMENT DEPARTMENT 62023
BUILDING DIVISION CITY OF
100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA92658YIW04*eEAerr
�2 p2?j ^ o (� ` www.newportbeachca.gov (949) 644-3200
Application for Report of Residential Building Records
Application Fee: - $202.00 Notice:
(For AIIResidential Buildings) Applications with insufficient fee payment
Reinspection Fee $134.00 or incomplete will be returned
Please type or print and complete all information
#of Units: l Address: 9 Sundance Drive Unit41 city: Newport, Beach state: [CA Zip: 92663
Propertyowner: Patrick William Healy
Owner Address: I !; City;
Zip Code:
State: CA Zip Code:—''....
Home Phone:
Owner's Authorized Agent:
Work Phone:
Agent Address:
City:
State:
�— Zip Code: F Agent Email Address:
Escrow Company: Freedom Escrow
J Escrow #: 055724-MM
Escrow Address:
1200 Newport Center Dr., Suite 180 city:
Newport Beach
State: FCA — Zip code: 1 92660
_... _
Escrow Phone (949)644-3939 J
Email Report to:
m-- -- —m@freedomescrow.COm
-- — -- .—. - --
— —
For Inspection call (Name):
, Direct Phone:
N/A
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/Agent's signature to authorize inspection:
Owner/Agent's signature to decline
Date:
OR
z Tlf�d�n� 40� Date: �p
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Account # 01050504-521040.................Make checks payable to: C/TYOFNEWPORTBEACH
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