HomeMy WebLinkAboutPA2021-273_20211110_ApplicationCommunity Development Department Planning Permit ApplicattQll 100 Civic Center Drive Newport Beach, California 92660 949 644-3200 newportbeachca.gov/communitydevelopment
1.Check Permits Requested:�/.ol6?--t-��3
.P, Approval-in-Concept -AIC # 0 Lot Merger
�oastal Development Permit )K!. Limited Term Permit --D Waiver for De Minimis Development O Seasonal D < 90 day � days
D Staff Approval D Tract Mcip p Traffic Study 0 Coastal Residential Development D Modification Permit D Condominium Conversion D Off-Site Parking Agreement D Comprehensive Sign Program D Planned Community Development Plan
rMAA.Jse Permit -□Minor □conditionalIJT/r D Amendment to existing Use Permit D Variance D Development Agreement D Planned Development Permit 0 Amendment -□Code □PC □GP 0LCPD Other: D Development Plan D Site Development Review -D Major D Minor 0 Lot Line Adjustment D Parcel Map
2. Project Address(es)/Assessor's Parcel No(s)I � fdCJ lv'-atl ;J It. 71 3.Project Description and Justification (Attach additional sheets if necessary):
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Applicant/Company Name I
Mailing Address I /� r1 J
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Phone I ql( q l �]--Fax I Email
Contact/Company Name I 2' f-· I 0 !+viii_
Mailing Address I: zJob tJ ( t A I ±.> I City I t/ , A ✓State J {!_ {;._ ., I Email Phone I
Suite/Unit I Zip'
Suite/Unit I Zip I
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I < #t111, I 6.Property Owner Name ,:,,..._�....c/---=e-'_' C_j_1 _D _______ -tr _________ -;:.-=--=--=--=--=--=---=---=---=--=;-"
Mailing Address .;.._I _ _........ _____________ · �._,;_q..._o _f_=f_--'--0_!=--i:::::1 =L===-=--='-S_u_ite/Unit .;.._I,...:-_-.....,:-_-_-_-___:-_�-' City 1 , /3.State I (!_ tL · I Zip I 'l ,,J& ,(__? I
Phone I 9 � 9. YI J I t-/ OJ T Fax I ----1 Email I A V I / fle t J-{J '-j frl a I f.
7.Property Owner's Affidavit*: (ii (We) I _!;et J IO )IL V I /A-I
depose and say that (I a (we are the owner(s) of the property (ies) involved in this application. (I) (We) further
certify, under penalty of rjury, t t the foregoing statements and answers herein contained and the infonnationall res , cts true and correct to the best of (my) (our) knowledge and belief.I () !J/ I I 1 j .. ;7s--;}_1I Signature(s): -----.lr-+ ......... -+--,..,r;........_ _______ Title: liv b!L,, f_ ft' Date: '-------�-
MMtooJYEAR
Signature(s): ______________ Titl{ ___________ __.I Date:,.__ ____ ___,
*May be signed by the lessee or by an authorized agent if written authorization from the owner of record is filed concurrently with theapplication. Please note, the owner(s)' signature for Parcel/Tract Map and Lot Line Adjustment Application must be notarized.l:\Users\CDD\Shared\Admin\Planning_Division\Applications\Application_ Guidelines\Planning Permit Application_2021.docx Rev: 01/24117
PA2021-273
I:\Users\CDD\Shared\Admin\Planning_Division\Current_Templates\Office Use Only Form Updated 01/27/2020
2700-5000 Acct.
Deposit Acct. No. ________________________
For Deposit Account:
Fee Pd: _______________________________________
Receipt No: ____________________________
FOR OFFICE USE ONLY
Date Filed: _______________________
APN No: __________________________
Council District No.: _________________
General Plan Designation: ____________
Zoning District: _____________________
Coastal Zone: Yes No Check #: __________
Visa MC Amex # ____________
CDM Residents Association and Chamber
Community Association(s): _______________________Development No: __________________________
_____________________________________________Project No: ________________________________
_____________________________________________Activity No: _______________________________
Related Permits: ___________________________
Remarks:
________________________________________________________________________________________
PA2021-273
PA2021-273