HomeMy WebLinkAbout19-7-17 Signed applicationHARBOR PERMIT
TRANSFER APPLICATION
100 Civic Center Drive
Newport Beach, CA 92660
949-644-3044
**Date of Applicaton: Prmjlumber:
**Property Address: � 7
**Buyer's Names:�{%� j/pG L
Buyer's Signatures
Billing Address:
Telephone No.: 9�4- ��f y y ? qao
**Seller's Names:
Seller's Signatures:
Joint Owner Signature:
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COMMUNITY
JUL X r REC'D
C, DEVELOPMENT
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**Escrow Company:&f Phone#
**Address/,&,O ��
**Escrow Number: p **Fax #1V9•- 3,
Closing Date (Estimate):S-_? p Email:
*-*STARRED ITEMS MUST BE COMPLETE TO BEGIN THE PROCESS.
Inspection Date: °) Reinspection Date:
Fee Paid: Check No:
Application Complete: ���
Harbor Resoufrcys Signature/Date
Special Conditions: This permit is revocable by the City Council
in accordance with Title 17 of the Newport Beach Municipal Code.
INSPECTION FORM
Harbor Resources Department
Date: �L
Inspection Requested By:
Inspector: 1.
Pier Address:
Pier Transfer
Reinspection
-- GFI Present Yes Need None Needed Yes Need
Anti -Siphon / Backflow Present
�s
Other Comments
Pump Out
Pier Location
Yes No
Operational
Recommended Action
Encroachment
Address of Complaining Party
Boat Description
CF Number
Location on Dock
Comments / Observations
Other Request