HomeMy WebLinkAbout16-8-10 trnsfr app4
o HARBOR PERMIT
TRANSFER APPLICATION
F � �
829 Harbor Island Drive
Newport Beach, CA 92660
949-644-3044/fx 949-723-0589
**Date of Applicaton: g11a1/6o Permit Number:
**Property Address: 6/g V,4,6rd
cA 9 0,1,6 3
**Buyer's Names:
Buyer's Signatures:
Billing Address: 6 /8 Vim 6-de Va
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Telephone No.: FF7— 1/// S
**Seller's Names: �ra ��, �. P�� r►� ✓�
Seller's Signatures:
Joint Owner Signature:
141
**Escrow Company: 3txp G�f Cscr&.-) Phone#
**Address l Yw �tl�.��L (�•►kr �64, M g7ao
**Escrow Number: t6,p► IS-YY5_7--J,11 **Fax #: 9Y9-V,2e /(j(9-�'
Closing Date (Estimate): 8/3)//& Email: JGsow-) e 3lve 1,,�; �sci�, �•�
* *STARRED ITEMS MUST BE COMPLETE TO BEGIN THE PROCESS.
Inspection Date: I 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:
Inspection Requested By:
Inspector:
Pier Address: < < A' -
Pier Transfer
GFI Present
Anti -Siphon / Backflow Present
Other Comments
Eelgrass
Reinspection
Yes Need None Needed Yes Need
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
CF Number
Location on Dock
Comments / Observations
Other Request