HomeMy WebLinkAbout18-4-18 Signed app-rransiu rcz, $ Z3V1 , �- iJ14-s (`rvro Yale I;. l5clAy s )
.viiPoR
-- � HARBOR PERMIT
�M TRANSFER APPLICATION
' n 100 Civic Center give
Newport Beach, CA 92660
949-644-30U
oari
**Date of Applicaton: j$ Permit Number:
**Property Address: Via Ii dQ NOY`-4
**Buyer's Name
Buyer's Signature
Billing Address.
Telephone No.:
**Seller's Names:
Seller's Signatures:
Joint Owner Signature:
**Escrow Company.:
**Address
**Escrow Number:
Closing Date (Estimate):
Ro
& v G w al Ct- C-S, C ryvv Phone# (14pq) 4`1$-7q 00
140D !N CWo `t Q�W lcr- �Dr 112-5 N C" R , r BCA- q2fo(af7
1Q-QRo g, '1 m **Fax #: (gc}q )4 0-7c<: 19
q u Email: yc�Son(� biv�watt�cSGrt�vv -can
;_STARRED ITEMS MUST BE COMPLETE TO BEGIN THE PROCESS;_
Inspection Date: Reinspection Date: /-
Fee Paid: Check N �'a`-r U 16
Application Complete:
Harbor Resource nature/Date
Special Conditions: This permit is revocable by the City Council
in accordance with Title 17 of the Newport Beach Municipal Code.
,2w,cc l.ed (-e4-r r/
Date:
Inspection Requested By:
Inspector:
Pier Address:
Pier Transfer
INSPECTION FORM
Harbor Resources Department
GFI Present
Anti -Siphon / Backflow Present
Pump Out
Other Comments
Pier Location
L
CQZ o VLSI
Reinspection
Yes Need None Needed
Yes Need
X
X
Il f l�
Yes No
Operational
Recommended Action
Encroachment
Address of Complaining Party
Boat Description
CIF Number
Location on Dock
Comments / Observations
Other Request