HomeMy WebLinkAboutR2022-0095 - Permit ApplicationPrint Form City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT COMMUNITY
n BUILDING DIVISION DEVELOPMENT
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92PMI*2022
RBR# �" l ✓ www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building RecorftIUF
Application Fee: - $198.00 Notice: 4 PORT BFPO
(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
9 I p state: CA Zip:F92625
# of Units: Address: 413 1/2 Marigold Ave City: Newport Beach
Propertyowner:1 Patrick Enriquez
Owner Address: I 413 1/2 Marigold Ave
State: CA Zip Code: F92625
Zip Code: 92625
City: Corona Del Mar
Home Phone:
Owner's Authorized Agent: I Wayne Smith/Laura Quinn Work Phone: 949-836-0705
Agent Address: 13407 East Coast Hwy City: I Corona Del Mar
State: -CA' Zip code: F92625 Agent Email Address: I laura@coronadelmarproperties.com
Escrow Company: I First American Title Escrow #: 6781991
Escrow Address: 1 4 First American Way City: I Santa Ana
State: CA Zip code: 92707 Escrow Phone: 714-250-4808
Email Report to:
orangeescrowl@firstam.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 that if Building or Zoning
violations are discovered l will be responsible to correct said violations
.Owner/Agent's signature to authorize inspection: ..Date:
OR
'Owner/Agent'ssignaturetodecline inspection: O Date;
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
BuIIE1ne_DIVI51on\Forms\RBR_7-1-21