HomeMy WebLinkAbout20200205_Application_LTPCommunity Development Department
Planning Permit Application
1. Check Permits Requested:
D Approval-in-Concept -AIC # D Lot Merger
D Coastal Development Permit J( Limited Term Permit-□ Waiver for De Minimis Development D Seasonal D < 90 day g4>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
D Development Plan D Site Development Review -D Major D Minor
D Lot Line Adjustment D Parcel Map
2. Project Address(es)/Assessor's Parcel No(s)
C~-~WirulRT BEACH ~ · 100 Civic'B'&iter Drive
Newport B1eP~,1 fplifornia 92660
. . .. ' 949 644-3200
newportbpachca.gov/communitydevelopment
0·11'., .·· C )' l. ~: .J GL(-.J ( .. :i
D Staff ApprovdfN 3 Vuai..) l~.:i, ,:dG
0 Tract Map AJ,INOIIVV\100
D Traffic Study 4~ 03Ar3'J~~
D Use Permit -iMinor □Conditional
D Amendment to existing Use Permit ·
D Variance
0 Amendment -□Code □PC □GP □LCP
D Other:
3. Project Description and Justification (Attach additional sheets if necessary):
/'/ f''."' t,. A .,, ,,! 4. Applicant/Company Name \., .. ~•"'i";\{;:;::11 .:·
Mailing Address z~/:'. ·';:l I Suite/Unit .:..-I_-~~-·_· _____________ __._
o.J.(,~ I / •'.'i1 . . t·' ,,,,< 7,,, City ✓' f.: y\ f i) ),;·. · ~
<.~ ,.,~,;
Phone,__·_··-~~--..L-"-'..---~
State ,~~-k:-·· .. -. ----, Zip I 1T2~2:) ----.,.,.a---, Email -'--I _ ....... _ .. ______ _______,
5. Contact/Company Name l l-~ ! i' ~tJt .. , pt;.,\/ IE,{ ~·J,, -JS~ Fk~rN.fE:f:!,.t;;, /' "' ,,J:::tl+t 1V••1c. vT'
Mailing Address J 177,f; ;z_ M \Td..f/1:::.U... 1-Jti/Z:ft+ I Suite/Unit I <l. I
City I I fY r Me:.-I State I (U\-I Zip I ·1.z,,.tf I
Phone Jqfi • 7'?2.... ll 77 Fax I -I Email I f !:!V J:o'l//;;;Q'... &. ~\J lTTEJZ ' lo1'v1 I
6. Owner Name ~ L-o/J ~ c:;. ~·
Mailing Address I zofi I \.) ~--12-~'i ~ V:i'!=--Suite/Unit ..__I __ .,,,_.:(•-=--=--=-====.
City I H:tst.u f.o¢t: ~M:V~-I I State ..__I -""'t:f'-"-<;:::~h=~··=====-=-~::....' .....:Z=ip~{.:::::::71/,~:::::c?f::::.f~::::::t='''?""=~,l==:;
Phone I jft-77~:,it:;GZ 71 Fax .,__I _--__ __,I Email .,___ _______ _______,
7. Property Owner's Affidavit*: (I) 0/Ve) ,:..___ _____________________ ____.
depose and say that (I am) (we are) the owner(s) of the property (ies) involved in this application. (I) 0Afe) 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): ______________ Title: I I Date: ...._I ____ ___.
DD/MO/YEAR
Signature(s): _____________ Title: ,!._I ________ ____JI Date: ...._I ____ ___.
*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.
PA2019-239