HomeMy WebLinkAboutR2022-0043 - Permit ApplicationCity of Newport Beach
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
V�01// 00 2 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA92658-8915
(/ J www.newportbeachca.gov 1 (949) 644-3200
Application for Report of Residential Building Records
Please type or print and complete all information
# of Units: Address: 207 Iris Avenue - City: Newport Beach State:CA ,ZIP: 92625
Propertyowner: Coons Family Trust Zip Code:
Owner Address: City:
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State: CA Zip Code: Home Phone
Owner's Authorized Agent: Work Phone:
Agent Address: City:
State: F Zip Code: Agent Email Address:
Escrow Company: Freedom Escrow Escrow #: 055136 -MM
Escrow Address: 11200 Newport Center Dr., Suite 180J City: Newport Beach
State: Cq Zip Code:92660 Escrow Phone: 1 (949) 644-3939
EmailReportto: mm@freedom escrow.COm
For Inspection c@11 (Name):N/Q _.. Direct Phone:
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
1 authorize inspections and re -inspections of the property listed above. I understand that if Building or Zoning '
violations are discovered I will be responsible to correct said violations.
Owner/Agent's signature to authorize inspection: 'Date:
OR
Owner/Agent's signature to decline inspection: clece%4— /3 y Ats Date: O/ •12 b • 2 Z
Account # 01050504-521040 ................. Make checks payable to: CITY OF NEWPORT BEACH
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