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HARBOR PERMIT
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TRANSFER APPLICATION
829 Harbor Island Drive
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Newport Beach, CA 92660
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949-644-3044/fx 949-723-0589
**Date of Applicaton: I1 I�. �5 Permit Number: 437 4CE
'Property Address: b}�TM
**Buyer's Names: NI a V-Cl! , DN iC 6 Lx- I'1lKyt} Y�A.VI
Buyer's Signatures: -k/,
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Billing Address:
LA 9171 /
Telephone No.:(201) 14
'Seller's Names: f Y1 e� nol Tr09t-
Seller's Signatures: ✓
Joint Owner Signature:
**Escrow Company:
'Address
je4DM ES Gy-i
'Escrow Number: b51231- M M
Closing Date (Estimate):
Phone# (q Hq) 0q y • 3'I3'1
* *STARRED ITEMS MUST BE COMPLETE TO BEGIN THE PROCESS.
Inspection Date: la S �5 Reinspection Date:
Fee Paid: Gj Ch ck No:
Application Complete:
Harbor Resabrces 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:
Inspection Requested By:
Inspector.
Pier Address:
CPi�erransfer
GFI Present
Anti -Siphon / Back -flow Present
Other Comments
Eelgrass
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40$ 36 " &.
Reinspection
Yes Need None Needed! Yes Need
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Date Time n 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
Encroachmenet
Address of Complaining Party
Boat Description
CF Number
Location on Dock
Comments / Observations
Other Request
Freedom Escrow - Trust Account
19646
Datel1/17/2015 Escrow No, 051234-MM Check Amount $`••••"285.00
OFFICER: Michael Migliore
Property: 408 38th Street, Newport Beach, CA 92663
Seller: The Frank G. McKenna Trust
Buyer: Marc A. Furstman and Nicole Furstman
Pier Transfer Report
for Pier Transfer Report 285.00