HomeMy WebLinkAboutR2023-0424 - Permit ApplicationDocuSign Envelope ID: 7DOA05EB-55CB-4649-91)2B-7D8EA4400591
Print Form City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT RECEIVED BY
COMMUNITY
BUILDING DIVISION DEVELOPMENT
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
R D �t Z- `t www.newportbeachca.gov 1 (949) 644-3200 MAY 15 2023
Application for Report of Residential Buildine RPrnrric CITY OF
Application Fee: - $202.00 Notice:
(For All Residential Buildings) Applications with insufficient fee payment
Reinspection Fee $ 234.00 or incomplete will be returned
Please type or print and complete all information
u of units: I Address: 1619 Arch Bay Drive
City: Newport Beach State: [CA Zip:92660
Propertyowner:I The Root Survivor's Trust, dated August 24, 1965
Zip Code:
Owner Address: 11619 Arch Bay Drive City: I Newport Beach
State: Zip code: 92660 Home Phone: 760-419-9902
Owner's Authorized Agent: I Brian Thomas Work Phone: I (949)422-6409
Agent Address: 11400 Newport Center Dr Ste 100 city: INewport Beach
State: F CA Zip code: 92660 Agent Email Address: I bthomas@Surterreproperties.com
Escrow Company: I CORNER ESCROW, INC /Ashley Bowman
Escrow Address: 18302 Irvine Blvd, #350 City:
State: FCA Zip Code: 92780
Email Report to: I ashley.bowman@cornerescrow.com
For Inspection call (Name):
Escrow u:l 10-14167-AB
Tustin
Escrow Phone: 1 714-922-3288
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
D0
0
u5Igned by:
Owner/Agent's signature to decline ¢, i" 5/12/2023 lYlA.9l. Ju.OiMA.S Date: —
r6B64E8F24004D0...
i. ,.— —a-auuffu ................. maKe cnecRs payable to: CITY OF NEWPORT BEACH
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