HomeMy WebLinkAboutR2021-0415 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION COMMUNITY
�n 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-&945,_r»meiNr,
RBR# � www.newportbeachca.gov 1 (949) 644-3200 JUN 9 4 2021
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Application for Report of Residential Building Records
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Application Fee: $194.00 Notice: Applications•` "th insuftfi#0ht fee
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Reinspection Fee $ 129.00 or incomplete will be returned
Please type or print and complete all information
# of Units:_ Address:415 1/2 Marguerite Avenue City: Corona Del Mar State: CA Zip: 92625
Property Owner: Adam T. Kent and Kristina Pucko
Owner Address: 415 1/2 Marguerite Ave. City: Corona Del Mar
State: CA Zip Code: 92625 Home
Owner's Authorized Agent: Carter Kaufman Work Phone:
Agent Address: 341 Bayside Drive, City: Newport Beach State: CA Zip Code: 92660
Mobil Phone: (949) 294-6411 Agent Email Address: carter(d)carterkaufman.com
Escrow Company: Mariners Escrow
Escrow Address: 270 Newport Center Drive, Suite 200
State: CA Zip Code: 92660
Email Report To: swelker@marinersescrow.com
For Inspection Call (Name):
Escrow # 60905 -SW
City: Newport Beach
Escrow Phone: 949-640-6040
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 I will be responsible to correct said violations.
Owner or Agent's signature to authorize inspection Date:
Owner or Agent's signature to decline inspection
6 /41 Z/b 74
Account # 2900-5005 ................. Make checks payable to CITY OF NEWPORT BEACH