HomeMy WebLinkAboutR2023-0394 - Permit ApplicationRECEIVED BY
City of Newport Beach COMMUNITY
DEVELOPMENt
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION MAY 0 5 2C i
100 Civic Center Drive ) P.O. Box 1768 ) Newport Beach, CA 92658-8915
R$I# �20Z3 — O3°I`") www.newportbeachca.gov ) (949)644-3200 CITY OF
NEWPORT BEACH
Application for Report of Residential Building Records
Application Fee: $202.00 Notice:
(For all Residential Buildings) Application with insufficient fee payment
Reinspection Fee $134,00 or incomplete will be returned
Please type or Print and complete all information
# of Units: 0 Address; 17 Currents City: New ort Beach Sate: CA Zip: 92657
Property Owner: Howard Perley, Trustee of the Survivors Trust under the Pedey Family Trust Zip Code:
Owner Address: City:
State: 0 Zip Code: Home Phone:
Owner's Authorized Agent: John Cain Work Phone:
Agent Address: 1200 Newport Center Drive Suite 100 City: Newport Beach
State: CA Zip Code: 92660 Agent Email Address:
Escrow Company: Granite Escrow & Settlement Services Escrow #: 04 47874 JJD
Escrow Address: 450 Newport Center Drive, Suite 600 1 City: Newport Beach
State: CA Zip Code: 92660 Escrow Phone: 949 720-0110
Email Report to: I jdannelle raniteescrow.com
For Inspection call (Name): Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED AND DATED BELOW)
1 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 inspection: Date: 5/3/23
Account # 01050504-521040...............—Make checks payable to CITY OF NEWPORT BEACH
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