HomeMy WebLinkAboutR2022-0062 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
�f1�6U110701Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
RBR # www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
=Application Fee: - $198.00 Notice:
'(For All ResitlentiafBuildings) Application with insufficient fee payment
RelnspecfionFee $:131.00 or incomplete will be returned
Please type or print and complete all information
# of Units: 1 Address: 18 Jetty Drive City: Newport Beach State: CA Zip: 92625
Property Owner: Robert W. Clemmer Zip Code:
Owner Address: 18 Jetty City: Newport Beach
State: CA Zip Code: 92625
Home Phone: 714)328-6787
Owner's Authorized Agent: Suzanne Wyrick Work Phone: 949)632-2890
Agent Address: 3 Curl Dr.
City: Newport Beach
State: CA Zip Code: 92625 Agent Email Address: Suz9921@gmail.com
Escrow Company: West Coast Escrow Escrow #: 4530622 -01004 -SEH
Escrow Address: 840 Newport Center Drive, Suite 150 City: Newport Beach
State: CA Zip Code:
Email Report to:
Escrow Phone: (949) 759-7072
;OM AND PLEASE SEND TO
For Inspection call (Name): DECLINED Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED AND DATED BELOW)
Bdldin Uwi.n\F.rt RBR_7-1-21