HomeMy WebLinkAbout18-4-4 pier trnsfr appDocuSign Envelope ID: 00OF033A-F5EO-4060-829E-24055511195A
HARBOR PERMIT
RECEIVED 8 r pv'X'C WORKS
MAY 4 2018
am OF Ityp"00" MACH
TRANSFER APPLICATION
100 Civic Center Drive
Newport Beach, CA 92660
949-644-3044
"Date of Applicaton: _,/•- / a( -,I �-Permit Number:
IProperty Address: '; /3)
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"Buyer's Names:
Buyer's Signatures:
Billing Address: tS `� 7 5T
C� G1 Z %6 3
Telephone No.: 71(1i3 V - f d T2
ISeller's Names: �Ct Trt,Z !-, N,il /ia ,4 rsuset,X K;11_4 7-d-sl-t-o-S
Seller's Signatures: IOU �
9803 9A9B72407..
347D3B0707A845D...
Joint Owner Signature:
"Escrow Company: l �Ar. 43rh C 5' L1,C0C_s Phone#
*Address i �o, c,) �'�),�� , nU rvr `�Lf )� l �' Cs. N1
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**Escrow Number: D Aq �q— A ij•1 **Fax #:
Closing Date (Estimate): 5jefi S Email: /h r%i � fA/-eef(o;%1 eSct'0c;j con
*-*STARRED ITEMS MUST BE COMPLETE TO BEGIN THE PROCESS.
Inspection Date: `ff(.%�( Reinspection Date:
Fee Paid: � Check No:
Application Complete:
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: s ll�
Inspection Requested By: 1---
Inspector:
Pier Address:
Pier Transfer
Reinspection
GFI Present Yes Need None N eded Yes Need
Anti -Siphon / Backflow Present
Other Comments
-fmcij 1 acces5
Pump Out
Pier Location 4kti
Yes No 1C jC_"
Operational
Recommended Action
Encroachment
Address of Complaining Party
Boat Description
CF Number
Location on Dock
Comments / Observations
Other Request