HomeMy WebLinkAbout21-5-5 Signed app & pymtHARBOR PERMIT
TRANSFER AI)PL.ICAT ON
100 Civic Center Drive
Newport Beach, CA 92660
949-644-3044
**Date of Application:
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**Property Address:
12.01
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1= ear N povi- 4-e4c6,6f! 266
**Buyer's Names: J06 CIcar
Buyer's Signatures:
Telephone No.: �' r �+' ~= it°3 s /,"
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**Seller's Names:
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Seller's Signatures:a
Joint Owner Signature:
**Escrow Company: Ieeg E-scyouN Phone## ejs-g'qqwo7qq
**Address 19621f Gard6af'f 5A,
**Escrow Number: 60ji..A9.. S g
**Closing Date (Estimate): M&y 11,101k **Email:
*STARRED ITEMS MUST BE COMPLETE TO BEGIN THE PROCESS.
Inspection Date:1Z--ReBnspection`Date�®-�����- �
Fee Paid: _ �� � Check No: Af
Application Complete:
Public Wor s SignaturelDate
Special Conditions: This permit is revocable by the City Council
in accordance with Title 17 of the Newport Beach Municipal Code.
INSPECTION FORM
Date:
Inspection Requested By:
Inspector:
Pier Address:
/'Pier Transfer)
GFI Present
Anti -Siphon / Backflow Present
Other Comments
Comments / Observations
Other Request
Public Works
L,
Reinspection
Yes Need None Needed Yes Need