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HomeMy WebLinkAboutR2021-0438 - Permit ApplicationCity of Newport Beach COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION 1O0Civic Center Drive |P.O.Box 178D|Newport Beach, CAQ2858^8015 vvwow.nevvportbuaohou.gov|(S48)844'32OV Application for Report of Residential Building Records Application Fee: - $194.00 Notimei (For Ali Residential Buildings) Applications with insufficient fee payment Reinspection Fee $ 129.00 or incomplete will be returned Please type or print and complete all information �� #nfUnhc| Addnsz-r'\ ![�y:ewpc,!t Beach State: bJ\/Zip: / Property Owner: DpCode: OvvnerAddoeo:|�\|lY-\[|T\���-���' |City�| �j | ._�_ `��_/ State: FCA | Zip Code: Ft Home Phone: � Owner's Authorized Agent: |ku^rkPhone: AgentAddneo: city�| � -___----� State:FTF��� | Zip Code: Agent Email Address: |\� Escrow Company: Escrow #: EscrmwAddeo:| \'�)��[l � city: ---'-------'-^------------------' --/-��~--r'~-----�^-=`-=`��--------------' State:| (]�^ | Zip Code: Escrow Phone: `-=---__�-�. '/-_- Emai|Report to: For Inspection call (Name): Direct Phone: CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)