HomeMy WebLinkAbout20-5-4 Signed app1tI al e q ;i,ta �tli � � r'.
#4 Civic Center Drive
Newport Beach, CA, 92660
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*mate of Appllcston: i��rM t N rib r;
**Property Address: t 1 /7 C ,-
"Buyer's Nannew i r
Billing Address:
Telephone No.:
"Seller°s Names
Seller's Signatures:
Joint Owner Signature:
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**Escrow
* *STARRED ITEMS MUST BE COMPLETE TO BEGIN TFf Pf20GES5.
Inspectionr
Fee Pal
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aes e a
Reinspection.
Spacial Condidonst This, permit is revocable by the City Council
in accordance with Title 17 of the Newport Beach Municipal Coda.
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00 Civic Center 1hrives
92660
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"Buyer's dames. 'Ol l(l I e
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Buyers Signatures:
Telephone No;:
**Seller's Names
Sellers Signatures;
Joint OwnerSl nature:
**Escrow Company: 'z v', i�'%" r:Ph ina#��
"Ad#tress/# /tG1}Yr a
**Escrow Number t **Fa� t
Glasing [fete {Estimate}Em a ll:-1-C&ro ' ) Apr r" �e
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Inspection Date: ReInspection Date:
Check No;
Application * i .
Harbor Resources SignaturelDate
Special Conditions: This permit is revocable by the City Council
in accordance with Title 17 of the Newport Beach Municipal Code.
Date:
Inspection Requested By:
Inspector:
Pier Address:
Pier Transfer
INSPECTION FORM
GFI Present
Anti -Siphon / Backflow Present
Other Comments
Comments / Observations
Other Request
Public Works
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VLS
Need None Needed
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I
Reinspection
Yes Need
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