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HomeMy WebLinkAboutR2021-0189 - Permit ApplicationDacuSign Envelope I0-268B24$E-9EF7-49AE-W8E422099$71RE2 qtY0f*"0#A0#k COMMUNITY'DEVELOPDEPARTMENT BUILMOG(D"IGN 11 ! • Ce "•• or & _• (9,49),6"-32010, t Owner Address:' State's' Owner's Authorized ent Please tvoe or orint and eomLttete aii inforination Work Phone: IVERM. Agent Address^. Nva eyfi3ferOnu„Sit 1 # of Units : EMAddress ...Chandon , - CItY ? i aesfz..' Sate CA`: ZiP Proe rt P Y Owner:M. Agent Email AddressNam- Zi Code ` " Owner Address:' State's' Owner's Authorized ent ter ....:::HEMiiB-1. Work Phone: IVERM. Agent Address^. Nva eyfi3ferOnu„Sit 1 __. m .: .. , ...... ' City: +ire ..t'.p00 dh. ... ,. Zip Code w .. m ; Agent Email AddressNam- w o s. s e E• Esorow Address: �'d( U'N State: :-LCA Zip -Codas Email Report to. _E For Inspection call (Name) CONSENTTD:INSPECT (FORM MUST RESIGNED AND DATED: BELOW Atcoimt # RIQSQSQ4-Sa 044 „Make Checks payable to CITY Of NEWPORT BEACH