HomeMy WebLinkAboutR2023-0397 - Permit ApplicationRECEIVED BY
MUIN
Print Form CI of Newport Beach COMOPMEN
City P DEVELOPMENT
COMMUNITY DEVELOPMENT DEPARTMENT MAY 0 9 2023
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-89C11; of
jqwquoz-3 - 03gl www.newportbeachca.gov1 (949)644-3200 NEWpOW BEACH
Application for Report of Residential Building Records
Application Fee: - $202.00 Notice:
(For All Residential Buildings) Applications with insufficient fee payment
Reinspection Fee $134.00 or incomplete will be returned
Please tvoe or print and complete all information
# of Units: I ' Address: 7 Jupiter Hills Drive City: Newport Beach State: FZip: 92660
Property Owner: Patrick Cory Zip Code: F—
Owner Address: City:
State: I" Zip Code: F Home Phone:
Owner's Authorized Agent: Work Phone:
Agent Address: City:
State: F Zip Code: F Agent Email Address:
EscrowCompany: I Freedom Escrow Escrow #: 105581 0-MM
Escrow Address: 1200 Newport Center Dr., Suite 180 CityNewport Beach
State: FCA Zip Code: F92660 Escrow Phone: (949)644-3939
Email Report to: mm@freedomescrow.com
For Inspection call (Name): N/A Direct Phone: F
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 7�i1��� .ate � Date: (�S.ot_ Z3
Account # 01050504-521040 .................Make checks payable to: OTY OF NEWPORT BEACH
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