HomeMy WebLinkAboutPA2022-058_20220311_ApplicationCommunity Development Department
Planning Permit Application
1. Check Permits Requested:
D Approval-in-Concept -AIC # D Lot Merger
Iii Coastal Developrnent Permit D Limited Term Permit-
□ 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
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)
12641 Circle Dr. I 049-175-12
CITY OF NEWPORT BEACH
100 Civic Center Drive
Newport Beach, California 92660
949 644-3200
newportbeachca.gov/communitydevelopment p A-:Z. O?-A -Os;?
D Staff Approval
D Tract Map
D Traffic Study
D Use Permit-OMinor □Conditional
D Amendment to existing Use Permit
D Variance
0 Amendment -□Code □PC □GP 0LCP
D Other:
3. Project Description and Justification (Attach additional sheets if necessary):
I new ADU over rebuilt garage
4. Applicant/Company Name .;_IT_h_o_m_a_s_B_u_rg_e_r_A_r_ch_i_te_c_t ____________ ...... -_-_-_-_-_-_-_-_-_--i___.l
Mailing Address 133751 Pequito Dr Suite/Unit ___ l...--_-_-_-_-_-_-_-_~_I
City Joana Point State lcA I Zip 192629 I
Phone 1949 376 2126 I Fax _________ ~I Email ltom@thomasburgerarchitect.com I
5. Contact/Company Name ___ I s_a_m_e_a_s_a_p_p_lic_a_n_t _____________ :::::::::::=======-=--1
Mailing Address ------------------...... ______________ __. __ S_u_i_te/Unit -;:.-=--=-=======:::::I
City-----,.::::-..:::::::-..:::::::-..:::::::-~~----_-_-_-_-_-_-_---...--_-_-_-_-_-_ --' __ s_tate __ I-_-_::-_-_-_-_-_-_-_ __._l_z.....:;.ip_:-_ -_ -_ -_ -_-_-_-_---',I
Fax __ I ____ ___.I Email,:_._ __________ ____. Phone-'--_______ __.
6. Property Owner Name I Bill & Diane Menninger I
Mailing Address 12641 Circle Dr Suite/Unit -I-----,
City I Newport Beach State ....-lc_A ____ I Zip 192663 I
Phone 1949 640 0074 I Fax .-------1 Email lbmenninger1@gmail.com I
7. Property Owner's Affidavit*: (I) (We)-'--------------------------'
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.
Title: I oW~ loate: I g-j-di ~
MM/DD/YEAR
Signature(s): ?{A_uf::JL
-+--,,,"~---------Title: ___ I _~~~----~____.I Date: 13 -3 -c}O ~} 7
*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.
PA2022-058
PA2022-058
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:
________________________________________________________________________________________
PA2022-058