HomeMy WebLinkAboutPA2021-278_20211117_ApplicationCommunity Development Department Planning Perm it Application
1.Check Permits Requested:0 Approval-in-Concept -AIC # 0 Lot Merger O Coastal Development Permit O Limited Tenm Penmit -
0 Waiver for De Minimis Development O Seasonal O < 90 day 0>90 days 0 Coastal Residential Development O Modification Permit 0 Condominium Conversion O Off-Site Parking Agreement 0 Comprehensive Sign Program O Planned Community Development Plan O Development Agreement O Planned Development Permit 0 Development Plan O Site Development Review - D Major D Minor 0 Lot Line Adjustment O Parcel Map 2.Project Address(es)/Assessor's Parcel No(s)I l 41 4 A-l±u.r ()-. Dr-_
CITY OF NfWPO U BEACH
100 Civic Center Drive Newport Beach, California 92660 949 644-3200 newportbeachca.gov/communitydevelopment
0 Staff Approval D Tract Map D Traffic Study D Use Permit -□Minor □Conditional D Amendment to existing Use Penmit D Variance 0 Amendment -□Code □PC □GP □LCP D Other:
3. Project Description and Justification (Attach additional sheets if necessary):15\"<-�c,Q �.-u,cl,__, ""', V\A,-.J � -t\c.<e,� d Ad Lo_ .. d.1 ,-+,_-.,,_
4.Applicant/CompanyName l /r,�TV'D\ / -ra/\.e Dt.\.0U I
Mailing Address I �-a· 'E, C> 'I. <2> 4 0 \ I Suite/Unit ';=====:I, City I Loll\{; "'\.s-e (lo. c:/V\. State I <!._J.-I Zip I 9 ° � 0 f> I
Phone I t;(Q-z_. · �o l. 4 O -z.J Fax�----, Email I )Ct"--e iJ ('.\ +�J1� o • W I
5.Contact/Company Name I s� � A£ A:G?cv .f::I
Mailing Address Suite/Unit':===========:'
City '----;:========;-----;::::=====-�State �--;::=:=====-'�Z::.tiP:..:I=====:' Fax ,__ _____ ___.I Email ,...._ _____________ ........, Phone,__ ________ _,
6.Property Owner Name I t--.-l.4: -eo BoJ'Y\ M-tA. r""+D I
Mailing Address I \ 9 \ L\ A-�-t\A✓ 1--'1)\r Suite/Unit I
City I (:.Q-ro� � \---\.o..f State I QA-I Zip I q d" (o :;i-5 I
Phone '----------' Fax I I Email I "::½,it:Cl) bo M fucu-: ¼,J �
7. Property Owner's Affidavit*: (I) (We) I ka-tt-eo °J?O'lP:'� .. : to I
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 pe�ury, 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): (AA£, ,/°"'Title: I O (;Jyv-uc___ I Date: '-------'"-"'" MM/DD/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 theapplication. Please note, the owner(s)' signature for Parcel/Tract Map and Lot Line Adjustment Application must be notarized.
l:IUserslCDD\Shared\Admin\Planning_ Division\Applications\Application_ Guidelines\Planning Permit Applicalion_2021.docx Rev: 01124117
PA2021-278