HomeMy WebLinkAboutR2023-0421 - Permit ApplicationRECEIVED BY
City of Newport Beach COMMUNITY
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION MAY 10 NZ1
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
www.newportbeachca.gov 1 (949)644-3200 CJiVOF
R9R# I#,ZOZ3 -0421 NFyP00BEACFI
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: F—] Address: 1687 Vista Bonita I City: New rt Beach Sate: CA Zip: .92660
Property Owner: I SNM2 Corporation, a Nevada Corporation Zip Code: 0
Owner Address: I I city:
State: 0 Zip Code: 0
Home Phone:
Owner's Authorized Agent: I Melissa Sorensen I Work Phone:
Agent Address: 1540 South Coast Highway, Suite 202 1 City: La una Beach
State: CA Zip Code: 92651 Agent Email Address:
Escrow Company: I"Granite Escrow & Settlement Services Escrow #: I 04-47882-JJD
Escrow Address: 1450 Newport Center Drive, Suite 600 1 City: New ort Beach
State: CA Zip Code: 92660 Escrow Phone: 949 720-0110
Email Report to: I jdannelley@graniteescrow.com
For Inspection call (Name): I Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED AND 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:
m
Owner/Agent's signature to decline inspection:
Date:
Date: 5/8/23
Account # 01050504-521040..................Make checks payable to CITY OF NEWPORT BEACH
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