HomeMy WebLinkAboutR2023-0234 - Permit ApplicationRECEIVED BY
City of Newport Beach COMMUNITYDEVELOPMENT
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION MAR 17 2023
100 Civic Center Drive i P.Q. Box 1768 1 Newport Beach, CA 92658-8915
www.newportbeachca.gov 1 (949) 644-3200 CITY OF
(C20Z'� OZ2✓'`1 NEWPORTBEACH
RM
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: = Address: 1603 & 603 112 Jasmine Avenue City: New rt Beach Sate: CA Zip: 92625
Property Owner: Wade Family Charitable Foundation I Zip Code:
Owner Address city:
State: Zip Code: 0 Home Phone:
Owners Authorized Agent I Ash Lamont I Work Phone:
Agent Address: 1 1125 Victoria St #H I City: Costaq Mesa
State: FCA 'Zip Code: 92627 Agent Email Address:
Escrow Company: I Granite Escrow & Settlement Services i Escrow #: I 04-47692-JJP
Escrow Address: : 450 Newport Center Drive, Suite 600 City: Newport Beach
State: CA Zip Code: 92660 Escrow Phone: 1 (949) 720-0110
Email Report to: I iparker@graniteescrow.com
For Inspection call (Name): I Direct Phone:
CONSENTTO 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 violati S.
i
q Owner/Agent's signature to authorize inspection: Kl t � Date: 112-4
OR
Owner/Agent's signature to decline inspection: Date:
Account It 01050504-521040...... -- ........ make checks payable to CRY OF NEWPORT BEACH
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