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HomeMy WebLinkAboutR2021-0812 - Permit ApplicationCity of Newport Beach COMMUNITY DEVELOPMENT DEPARTMENT NOY BUILDING DIVISION 100 Civic Center Drive i P.O. Box 1768 1 Newport Beach, CA 92658-8915 Lwww.newportbeachca.gov 1 (949) 644-3200 Y of t RBR# Application for Report of Residential Building Records Property Owner _ :..a`� Zip Code: Owner Address. a ::. City MMN State Zip Code ...a?y r._ .._..m._.. Home Phone: = ___.rm Owner's Authorized Agent ."S17sleavlditi `etr; Work Phone: Agent Address:`43� O.Nei State ?;(:A Zip Code: Escrow Company: Agent Email Address: City: Escrow #: Escrow Address Please type or print and complete all information :m.. , City r ewpartBeach # of Units: 0 Address: s52p)aartdha.._^ City flew "drt,Bea`ch ,.:. ;' Sate � Zip. State. CA , ! Property Owner _ :..a`� Zip Code: Owner Address. a ::. City MMN State Zip Code ...a?y r._ .._..m._.. Home Phone: = ___.rm Owner's Authorized Agent ."S17sleavlditi `etr; Work Phone: Agent Address:`43� O.Nei State ?;(:A Zip Code: Escrow Company: Agent Email Address: City: Escrow #: Escrow Address e;: BiNport. nter,i3hye,Suate:800 .�. _:.:`m==-=-°€€r=;r„ :m.. , City r ewpartBeach ._..:.. State. CA , ! Zip Code ::.9'26$ ' .g :.. _....... Escrow Phone 11,' 04 Omb f 10 .. 7.m _. `i Email Report to II tiffdh '''rahite`escrowt�m .._...:..: __.......t nag _.wmm ._r .._:. For Inspection call (Name). 1-2".'... :....:......_ Direct Phone. ...,..,_ ..._ .:..:: , _... CONSENT TO INSPECT (FORM MUST BE SIGNED AND DATED BELOW Account # 01050504-521040 .................. Make checks payable to CITY OFNEWPORTSEACH