HomeMy WebLinkAboutR2023-0512 - Permit ApplicationPrint Form City of Newport Beach RECEIVED n
COMMUNITY DEVELOPMENT DEPARTMENT DEVELOPMENT
BUILDING DIVISION JUN 0 6 HO s
100 Civic Center Drive I P.O. Box 1768 I Newport Beach, CA92658-8915
R99# IC4V L� — b `� 1 Z www.newportbeachca.gov 1 (949) 644-3200 CITY OF
NEWPORT BEACH
Application for Report of Residential Building Records
Application Fee: - $202.00 Notice:
(For All Residential Buildings) Applications with insufficient fee payment
Reinspection Fee $134.00 or incomplete will be returned
Please type or print and complete all information
# of Units: 7 Address: 18 Calais
PropertyOwner:I Ken J. Gundersen and Elaine Gundersen
Owner Address: 18 Calais
State:ICA
Owner's Authorized Agent:
Agent Address:
State:
Zip Code: 92657
Zip Code:
Escrow Company: 17CEScrow, Inc.
City: Newport Beach State: CA Zip: 92657
City: i Newport Beach
City:
Agent Email Address:
Escrow Address: 1647 Camino De Los Mares #106
State: CA Zip Code: 92673
Email Report to: I carriem@7cescrow.com
For Inspection call (Name): I Elaine Gundersen
zip code: 92657
Home Phone: 1 (949) 294-3235
Work Phone:
Escrow #:I 01-2140-CM
City: I San Clemente
Escrow Phone: I (949) 429-7177
Direct Phone: I (949) 294-3235
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 correctsaid violations.
A '
Owner/Agent's signature to authorize inspection: ! fir Date: 61YI2003
OR
Owner/Agent's signature to decline
Date:
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Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH