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COMMUNITY DEVELOPMENT DEPARTMENT c, , OQ'/
BUILDING DIVISION AMvuN/rl,
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�n20 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8ftr
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Application for Report of Residential Building
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# of Units: Address:-_ry� City: Newport Beach State: CA Zip:
Property
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State: CA Zip Code:
Zip Code:
City:
Home Phone:
Owner's Authorized Agent: Work Phone:
Agent Address: ��l] �.�. ��-�- �(' a�(� J City:
State: Zip Code: Agent Email Address:
Escrow Company: 1L1L�--oa-�D �lZoc..� ` Escrow#:
Escrow Address: J City: LYI)
State: Zip Code: 2-i�io�l Escrow Phone:
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For Inspection call (Name): Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOWI
Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
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Account # 01050504-521040 .................Make checks payable to: CITY OF NEWPORT BEACH
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