HomeMy WebLinkAboutR2021-0798 - Permit ApplicationV 2oZl 04q �
DocuSign Envelope ID: F4A87874-A347-47DA-A7BE-54D6COFE6DF6
Print Form City of !Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
ti6flta BUILDING DIVISION
V /- ) 0 civic Center Drive I P 0 Box 1768 N w
Gort B ah, (1A 92658-891
vvr ne.wot�r?be I h a-Gcv (r3r d) &44 4 O7
Application for Report of Residential Building Records
kppl'icatUn„Fee:_- $198.00 Notice:
(For AIIResidential Buildings) Applications with Insufficient fea. payment
Reinspection Fee $131.00 or incomplete will he returned
please 4 e or runt and complete all information
Ofue'rs 38 Sea Island Drive c'v ;raewf, 3 rip: 92660
Propertyoukner Taylor M. Hensling z•1;:n<te. 92660
Ownar Address 38 Sea Island Drive city Newport Beach
$tate. ICA rp code. 92660 roma
Dwner's Aith rued Agent: Parra Etern rc 7hore 714-717-6408 _
Agent address: 17011 Beach Blvd_ #900 n Huntington Beach
store CA Lip "ode: 92647 Agent £rnailAddress. Pam@teameiem.Com
w co,m"auy Central Escrow Group, Inc. E"crow 4CEG907518-H,)
DwA.d rets: 2134 Main Street #185 11-'1tr Huntington Beach
State Ca r ,_ 8..._ Escrow pnone: 714-698-5982
Emad Report to heidi.james@centralescrowgroup.com
FCr Inspection call (Name(- Pam Etem i :ren phone. 714-717-6408
CONSENT TO 1NSRF.CT_{FORM MUS'r_BE SIGNED &-.OATF_b BFi.;JW)
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.y Lr;t�d above„understd rad tl+.et s ,;dlr�a or?�tr,ing
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CAmrrr (. RF,e nt'B s;gn .Korn U1 aatF r�rt « iesr?ertiien. Date
Docusign��:
11/17/2021
Gt+ne r'AP.Grr ;sir .trate to der�me r.�.tirn Law
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