HomeMy WebLinkAboutR2023-0400 - Permit ApplicationPrint Form
City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
RECEIVED BY
COMMUNITY
DEVELOPMENT
MAY 0 9 ZOD
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA92658-891SITY OF
RM#Q20Z5 vp4O0 www.newportbeachca.gov (949)644-3200 NEWPORTBEACH
Application for Report of Residential BuildinP Rernrdc
Application Fee: - $202.00
Notice:
(For All Residential 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: Address: 913 W. Balboa Blvd. City: Newport Beach State: CA Zip: 92661
Propertyowner: Charles Arthur Quillen Trust Zip Code: F—
Owner Address: City:
State: I"' — Zip Code: �— Home Phone:
Owner's Authorized Agent: Work Phone:
Agent Address: City:
State: �— Zip Code: F Agent Email Address:
Escrow Company: Freedom Escrow Escrow#: 055804-MM
Escrow Address: 1200 Newport Center Dr., Suite 180 city: INewport Beach
State: CA Zip code: 92660 Escrow Phone: 1 (949) 644-3939
EmailReportto: I mm@freedomescrow.com
For Inspection call (Name): I N/A
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/Agent's signature to authorize inspection: Date: �—
OR
Owner/Agent's signature to decline �9�' /} / A Qq-y3
111.. I". viujuav4-3Ziu4u .................IwoKe cnecks payable to: CITY OF NEWPORT BEACH
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