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City of Newport Beach o e
COMMUNITY DEVELOPMENT DEPARTMENT�r
BUILDING DIVISION C?�t�1;2fyy �O
Q(� 100 Civic Center newportbeachca eo NI (949) 644-32 Owport Beach, A 92658-8915 O,l �A LOJ
RBR# 2026—oU 2, "-Ml
Application for Report of Residential Building Records
# of Units: M Address:
Property Owner:
Owner Address:
State iR,?, Zip Code:
Please type or print and complete all information
City Iew ortBeaeF ?."€ Sate � Zip
Zip Code:
City:
Home Phone.
Owner's Authorized Agent ars-$fetiihi ,4. HWH U.
Work Phone:
Agent Address:
State: � Zip Code:
Agent Email Address:
City:
Escrow Company:suramtesirowi:SeementSeivrCes . _h'x' : „'.,,5 Escrow #:
Escrow Address: {°t 1 115`.etttet.FtY,.Niie &Op.0"j.ra`s City t3ew o
State � Zip Code �660a_,.';....s Escrow Phone:'x,44 , - =A111
Email Report to: ttiGrti111'Yt iaelkeescYcawoorr ..., ... , .. MR -M-1-1,
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For Inspection call (Name) 5,;o- ,:..,,.,., q„ 3 ;� ,, . Direct Phone an
-_-- ---- -- CONSENT TO INSPECT (FORM MUST BE SIGNED AND DATED BELOW
Account # 01050504-521040 .................. Make checks payable to CITY OF NEWPORT BEACH