HomeMy WebLinkAboutR2021-0586 - Permit Application-----------------
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City of Newport Beach aoIUMUN€I
COMMUNITY DEVELOPMENT DEPARTMENT DEVELOPM ti'1
BUILDING DIVISION I
100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA9261WA53 2021,
www.newportbeachca.gov 1 (949) 644-3200
CITY OF -
Application for Report of Residential Building Records
Application Fee: - $198.00 Notice: Yypotn
(For AIIResidential Buildings) Applications with insufficient fee payment
Reinspection Fee $131.00 or incomplete will be returned
Please type or print and complete all information
#of Units: FF Address: 2 Summerwalk Ct #33 City: Newport Beach State: CA Zip: 92663
63
Propertyownerf Peter Bukiri and Marilyn Bergstrom Zip Code: F 1-2�
Owner Address: 6917 E. Horizon Drive _ City: Orange
State: CA Zip Code: F
92867 Home Phone: 714.345.5433
Owner's Authorized Agent: Mackenzie and Cannon Work Phone: 949.337.0926
Agent Address: 6833 Quail Hill Parkway City: Irvine
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State: CA Zip Code: 92603 dave@macteam.com
� Agent Email Address:
Escrow Company:
West
Coast
Escrow
Escrow#:
4530221-07433
Escrow Address:
6833
Quail
Hill Parwkay
City:
Irvine
State: CA Zip Code: 92603 Escrow Phone: 949.854.7353
Email Reportto: I Nicole. Matteson @WestCoastEscrow. com
For Inspection call (Name): ave Cannon - Direct Phone: 949.337.0926
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 1 will be responsible to correct said violations.
Owner/Agent's signature to authorize inspection: gvoL Date:I/Id- a,�
OR
Owner/Agent's signature to decline inspection: - Date: T -al
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
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