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Community Development Depa· · PA2018 _002 for zc201s-001
Planning Permit Applic 2727Shel\Street
John Vengoechea ,r-Ty Q~"+-3200
1. Check Permits Requested:
D Approval-in-Concept -AIC # D Lot Merger
D Coastal Development Permit D Limited Term Permit -
D Waiver for De Minimis Development D Seasonal D < 90 day 0>90 days
D Coastal Residential Development D Modification Permit
D Condominium Conversion D Off-Site Parking Agreement
D Comprehensive Sign Program D Planned Community Development Plan
D Development Agreement D Planned Development Permit
. . ..... "'vnoeacnca.gov/communitydevelopment
D Staff Approval
D Tract Map
D Traffic Study
D Use Permit -OMinor 0Conditional
D Amendment to existing Use Permit
D Variance
D Development Plan D Site Development Review -D Major D Minor
D Amendment -DCode OPC OGP DLCP r, Other: 'Z-,,~ \ \\\.(., C U..At€A~c.C
D Lot Line Adjustment D Parcel Map
2. Project Address(es)/Assessor's Parcel No(s)
I -2., 2 7 4:5'\;fet,L c::;..:rf:.Ee'C
3. Project Description and Justification (Attach additional sheets if necessary):
I Ac.c.~o J;l...'t; DWe;u.... l ~ e\. Ut-1. \T
4. Applicant/Company Name I 'I:o tH-l \{ Cc:DN b,O~A /
Mailing Address I '7 (p U \:,\.ew MILT A~ U~ Suite/Unit I
City I Lo = ge:Av\d: I State .--lc_AL_LE-ca.--, A.-, Zip I C( oe o Y J
Phone ~oS):56G,-Cf~91 / Fax'---____ __.! Email I :3~\le..N,&o@,., '(A:~oo, c.o M I
5. Contact/Company Name -'-I~----~~..,..~--~~-~t\1-Liso.-~"Lik--___________________ _,/
Mailing Address '-----------------------' Suite/Unit.....-------/
City -'---:=================:;----;:========::::: State ..--------, Zip /
Phone Fax,---------, Email.,__ ____________ ____,
6. Owner Name IM \C.\:\~t; L .. r!h)t::r\E. (....
Mailing Address I '& ".'Z '2-'7 :5;;, \w;:.._ L ~"tf t;['I / Suite/Unit _____ _,
City I W'.z.o Ill ~ "D6L. t-.\MZ.. State I CA Ll Et.ll(L\1-l t A / Zip I '(:'.U., ?. S
Phone lrn~J S' l 2..-7'5~0 I Fax I Email I t1 t" v ~eL.@.; e\-11£.£.t\ \{~, (bvf
7. Property Owner's Affidavit*: (I) (We) I 1,----1---tvr-~--~-_..:;;>
depose and say that (I am) (we are) the owner(s) of the property (ies) involved in this application. (I) (We) further
certify, under penalty of perjury, that the foregoing statements and answers herein contained and the information
herewith submitted are in all respects true and correct to the best of (my) (our) knowledge and belief.
Signature(s): ,,,....--:::S~~~.__-s ~ Title: ,__, _..;;..O_w_~ _____ ___,, Date: 1 , 7 z / t co
DO/MO/YEAR
Signature(s): --------------Title: :.___ ________ __. Date: '---------'
*May be signed by the lessee or by an authorized agent if written authorization from the owner of record is filed concurrently with the
application. Please note, the owner(s)' signature for Parcel/Tract Map and Lot Line Adjustment Application must be notarized.
F .IUserslCDDIShared\Admin\Planning_Oiv1sion\Applications\Application _ Guidelines\Planning Permit Application -CDP added.docx Rev· 01/24117