HomeMy WebLinkAbout18-4-20 Signed appsDocuSign Envelope ID: DFDAF073-8FCB-4287-A27E-695D45FB9A83
HARBOR PERMIT
71
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f'ij
y, TRANSFER APPLICATION
100 Civic Center Drive
--K:, Newport Beach, CA 92660
949-644-3044
**Date of Applicaton: _?-, �- IS Permit Number:
**Property Address: 1 I I 1 N16W) +
**Buyer's Names: �i L�'lGit�r_� F �(,yeS Q ()Eca a E LVC 5
Buyer's Signatures:
Billing Address:
Telephone No.:
**Seller's Nary
Seller's Signatu
Joint Owner Signature:
**Escrow Company: -�-I(PQALYYq (_-frlyj Phoneefl--(14 -�9 Y)
**Address _1206 NOnl 14)KI CPAt- i)v (�'U N( C) C42-Q(tb
**Escrow Number: QS-2�}�S ( **Fax #: C1444 40-��
Closing Date (Estimate): -I�- Email: -Fred i ,,Vj, Cf;��
*STARRED ITEMS MUST BE COMPLETE TO GIN THE PROCESS.
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Inspection Date: �-E�%t8 Reinsp.ection Date: �`
Fee Paid: `rla,3 I Chick No:
Application Complete:
Harbor ReWurces Signature/Date
Special Conditions: This permit is revocable by the City Council
in accordance with Title 17 of the Newport Beach Municipal Code.
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HARBOR PERMIT RECE,
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TRANSFER APPLICATION eyn�,at►c woRK3
100 Civic Center Drive APR 2 O 2018
Newport Beach, CA 92660 c►ryo,�h""o
949-644-3044 RT® 4cH
**Date of Applicaton: Permit Number:
**Property Address: k I
taQC S n AC121da-
**Buyer's Names:
Buyer's Signatures:
Billing Address
,Telephone No.:
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**Seller's Names: ��cY!'�Qs � s i%(Y_q Gar<Ac nsejo
Seller's Signatures:
Joint Owner Signature:
**Escrow Company: Ty_eQ(j(yyj C_,5C0/j Phone# ILFJ-LCW -�9 �e)
**Address
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**Escrow Number: 1-" **Fax #: CYj-U U-��
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Closing Date (Estimate): -1- Email: -Prep GVt1,
* *STARRED ITEMS MUST BE COMPLETE TOWGIN THE PROCESS.
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Inspection Date: Reinspection Date:
Fee Paid: d f '-+ Check No:
Application Complete:
Harbor Res`Surces Signature/Date
Special Conditions: This permit is revocable by the City Council
in accordance with Title 17 of the Newport Beach Municipal Code.
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INSPECTION FORM
Harbor Resources Department
Date: 3
Inspection Requested By:
Inspector: L-
Pier Address: rV b I
Pier Transfer
l Reinspection
GFI Present Yes Need None Needed Yes Need
Anti -Siphon / Backflow Present
Other Comments
Pump Out
Pier Location
Yes No
Operational
Recommended Action
Encroachment
Address of Complaining Party
Boat Description
CIF Number
Location on Dock
Comments / Observations
Other Request