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HARBOR PERMIT
TRANSFER APPLICATION
829 Harbor Island Drive
Newport Beach, CA 92660
949-644-3044/fx 949-723-0589
**Date of Applicaton: y-21-/6 Permit Number:
**Property Address: -1/ Bay :� la nl
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**Buyer's Names: _4AIDy ,cwTHDGL�/// , Trus�ec o� tie
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Buyer's Signatures:
Billing Address:
Telephone No.. -
'Seller's Names: 7ean /t�asmussen
Seller's Signatures: Caw.Q ,Owe /�a�a•..w�•
Joint Owner Signature:
**Escrow Company: Key Escrow, Inc. Phone# (949) 698-1960
**Address 660 Newport Center Dr, fit€ 200, Newport Beach, CA
**Escrow Number: poa56o **Fax #: Oqq) 6lif /q6/ 92660
Closing Date (Estimate): 5 -/6 -16 Email: ��/1e c. j�er,crsc�ow. 00--?
* *STARRED ITEMS MUST BE COMPLETE TO BEGIN THE PROCESS.
Inspection Date:
Fee Paid:
Application Complete:
Reinspection Date:
Check No:
Harbor Resources 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
TRANSFER APPLICATION
829 Harbor Island Drive
Newport Beach, CA 92660
949-644-3044/fx 949-723-0589
**Date of Applicaton: y-ZI-16 Permit Number:
**Property Address: / Bay
**Buyer's Names: VIVO y
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Buyer's Signatures:
M . - .
**Seller's Names: ��rro// deal, , % e-ktsAe_e_
Seller's Signatures:
Joint Owner Signature:
**Escrow Company: Key Escrow, Inc. Phone# (949) 698-1960
**Address 660 Newport Center Dr. SE0 200, Newport Beach, CA
**Escrow Number: Doa3�60 **Fax #: (4,q) 6ji8 /q6/ 92660
Closing Date (Estimate): 5 -/6 -/6 Email: l p-/,e � Xeke- ow, ooh-,
v — - v
* *STARRED ITEMS MUST BE COMPLETE TO BEGIN THE PROCESS.
Inspection Date:
Fee Paid:
Application Complete:
Reinspection Date:
Check No:
Harbor Resources 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:
Inspection Requested By:
Inspector:
Pier Address: —mil Ct
Pier Transfer
Reinspection
GFI Present Yes Need None Needed Yes Need
Anti -Siphon / Backflow Present
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Other Comments
Eelgrass 1
Date Time ❑ Eelgrass Within 15' of Project
Eelgrass Within 15' - 30' of Project
❑ No Eelgrass in Project Area
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