HomeMy WebLinkAboutR2022-0284 - Permit ApplicationDocuSign Envelope ID: D8280B6F-F522-4A15-AC30-7EO95F43CO65
DECEIVED gY
COMMUNITY
DEVELOPMENT
Print Form City of Newport Beach JUN 0 7 2022
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
0 ivic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915 CITY OF
RBR# ti f www.newportbeachca.gov i (949) 644-3200
Application for Report of Residential Building Records 2"pDRr WIG"
Application Fees: Single Family KeslUonoo(I unit) -�1 b5.uu Notice:
Duplex (2 Units) - $192.00 Application with insufficient fee payment
More than 2 units - $192.00 + 11.00 per unit over 2 or incomplete will be returned
Reinspection Fee $88 00
Please type or print and complete all information
# of Units: Address: 2681 Bayshore Drive City: Newport Beach State: CA Zip: 92663
Property Owner: Ryan Steelberg, Trustee of the R.S.S. Living Trust, dated 04/06/2012
Zip Code:
Owner Address: 2685 Bayshore Drive_ City: Newport Beach
State: CA Zip Code: 92663 Home Phone:
Owner's Authorized Agent: Anne Stiefel
Agent Address: 450 Newport Center Dr., Ste. 100
State:CA Zip Code: 92660 Agent Email Address:
Work Phone: (949)717-6000
City: Newport Beach
Escrow Company: Key Escrow, Inc. Escrow # 006193-BR
Escrow Address: 450 Newport Center Drive, 230 City: Newport Beach
State: CA Zip Code: 92660 Escrow Phone: (949)698-1960
Email Report To: brandi@keyescrow.com
for Inspection Call (Name):
Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
I authorize inspections and re -inspections of the property listed above. I understand
violations are discovered I will be responsible to correct said violations.
Owner/Agent's signature to authorize inspection: Date: DECLINED
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Owner/ Agent's signature to decline inspection: Wiw.. Sfu.ILug, %4- Date: 6/6/2022
Account #2900-5005........... Make checks payable to CITY OF NEWPORT BEACH