HomeMy WebLinkAboutR2022-0020 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT �ECFfVHp 9y
BUILDING DIVISION COMMUNITY
V(�Q 1 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658DWt5OpMENT
RBR # 1 V'rZ��O 0 Gd www.newportbeachca.gov 1 (949) 644-3200 q
Application for Report of Residential Building Records fl 4 �022
Application Fee: -$198.00 Notice: ClTYCF
(For All Residential Buildings) Application with inficient fee ryment
Reinspection Fee $131.00 or incomplete will be ret< TiiW
Please type or print and complete all information
Newport Beach
(Corona Del Mar
# of Units: Address: 34 Jetty Drive City: Area) State: CA Zip: 92625
Zip
Property Owner: Fred and Ann Stern, Trustees Code:92625
Owner Address: 34 Jetty Drive City: Newport Beach
State: CA Zip Code: 92625 Home Phone: 617)529-1146
Owner's Authorized Agent: Suzanne Wyrick Work Phone: 949)466-3161
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 -00254 -SEH
Escrow Address: 840 Newport Center Drive, Suite 150 City: Newport Beach
State: CA Zip Code: 92660 Escrow Phone: (949) 759-7072
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Email Report to: Sandi Ineben@westcoastescrow com 9r T�L11Y1 NE(3 /��[� It�P��-CnC�s f�SCrDet)
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For Inspection call (Name): DECLINED
Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED AND DATED BELOW)
1 authorize inspections and re ipspections of the
are discovered 1 will be resporisibletomorrect sa
Owner/Agent's signature to authbrize inspection
Owner/Agent's signature(i decline'spectioni
Building_Oivi,,.*.rm \RBR_7-1-21
)roperty listed above. I understand that if Building or Zoning violations
1:violations.,
Date
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