HomeMy WebLinkAboutR2021-0244 - Permit ApplicationDoc --,Sign Envelope ID: 8AA28085-5E74-48BE-988F-5666525C331 E
City of Newport Beach
Int inn A -
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-4,9;a y) ..1 7 i
F L L t 1 www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
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Application Fee: -$194.00 Notice:
(For All Residential Buildings) Applications with insufficient fee payment
Reinspection Fee $129.00 or incomplete will be returned
Please type or print and complete all information
# of Units: F1 Address: 27 sea Island orlve __. City Newport Beach , State CA Zip 926so
Property OWner:I Robes and Connie auckenberyer
Owner Address: 332 Warwick Ave
State: CA Zip Code: 93619
Zip Code: F92660
City: Clovis
Home Phone: 1559-267-5369
Owner's Authorized Agent Connieeuckenbarger _... Work Phone: 5592975389 !.
Agent Address: 1170EChamplain or#los City:Fresno
State: CA Zip Code: F93720 Agent Email Address: connie@alulsi.com
Escrow Company: Taylor escrow '.. Escrow #: 21 -7080 -DD
Escrow Address: 3 Monarch Bay Plaza #104 City: Dana Point
State: CA ' Zip Code: 1 92629 Escrow Phone: 949-380-6589 .
Email Report to I Deldre@taylorescrowcom
For Inspection call (Name) I 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 l will be responsible to correctsaid violations.
Owner/Agent's signatureto authorize inspection Date:
aoce9l9ne4 by: OR
Owner/Agent's signature to decline inspection:Crblad4A,61A&tkt,t.Vf�tV Date: 3/25/2021
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Account # 01050504-521040.................Moke checks payable to: CITY OF NEWPORT BEACH
Bu lid ing Dlvision\Forms\R8R7-3020