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DocuSign Envelope ID: A4F2027A-6DF640(14-AD92-2C4DDE8E41 DF COMMUNITY
nEVELOPMENT
ViAR 12 2020
City of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT eiTY OF
BUILDING DIVISION
100 Civic Center Drive i P.O. Box 1768 i Newport Beach, CA 92658-8915 rWPORT ��&
d / www.newi)oribeachea.gov i (949) 644-3200
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Application for Report of Residential Building Records
Property Owner:
Zip Code:
Owner Address
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Property Owner:
Zip Code:
Owner Address
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Zip Code
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Home Phone:N
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Owner's Authorized Agent. °pnrnlrlrcTlcci= r Work Phone:
Agent Address 455,0 N,__, Wehker#t00 ..:.:;.... .._..__.. City 7Jeiy{
State � Zip Code:
Agent Email Address:
Escrow Company: ranite rorrtY &,keit ei7lepf„�aeriace5 ,rE
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Escrow Address:
City:
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Escrow Phone 99 .Z20 i?110
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For Inspection call (Name) �t� - .'._m..;, s __,. zr,z,;; Direct Phone:
CONSENTTO INSPECT (FORM MUST BE SIGNED AND DATED BELOW
Account # 01050504-521040 .................. Make checks payable to CITY OF NEWPORT BEACH