HomeMy WebLinkAboutR2021-0756 - Permit ApplicationPrint Form City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
��/��I , /� r i1�0 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
RBR# l/ 1 v l "J �,l' www.newportbeachce.gov 1 (949) 644-3200
Application Tor Report of Residential Building Records
Anolication Fee: - $198.00 Notice:
(For All Residential 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: I ' Address: 25 Canyon Island Drive City: Newport Beach State: CA ZZip: 92660-51151
Propertyowner: Alex and Jennifer Froemke Zip code: F92660
Owner address: 1 25 Canyon Island Drive city: Newport Beach
State: FCA zip Code: 92660 Home Phone: 1 714-812-6743
Owner's Authorized Agent: Jennifer Froemke
Work Phone: 714-812-6743
Caldwell Banker Realty, Huntington Beach
Agent Address: I 19440 GOldenwest St. city: FHuntington Beach
State: FCA i Zip Code: 92648
Agent Email address: I jennifer.froemke@cbrealty.com
Escrow Company: I CORNER ESCROW INC. Escrow#:I 08-10676-VK
Escrow Address: 18600 MACARTHUR BLVD.#350 City: FRVINE
State: CA Zip Code: F92612 Escrow Phone: 1 949-800-8908
Email Report to: vesna.kopac@cornerescrow.com and jennifer.froemke@cbrealty.com
For Inspection call (Name): Jennifer Froemke Direct Phone: 1 714-812-6743
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
I authorize inspections and re -inspections of the property listed above. I understandthat if Building or Zoning
violations are discovered I will be responsible to correct said violations.
Owner/Agent's signature to authorize Inspection 1 Bate: to I '251 Z
/ OR —"`
Owner/Agent's signature to decline inspection: ,/ Date:
.................MaKe Cnecxs payable to: CITY OF NEWPORT BEACH
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