HomeMy WebLinkAboutPA2022-0283_20221201_Discretionary Application Owner's AffidavitCommunity Development Department
Discretionary Application
Owner's Affidavit
1. Check Permits Requested:
0 Approval-in-Concept -AIC #
O Coastal Development Permit
D Waiver for De Minim is Development
0 Coastal Residential Development
0 Condominium Conversion
0 Comprehensive Sign Program
0 Development Agreement
0 Development Plan
~ Lot Merger
0 Limited Term Permit -
D Seasonal D < 90 day 0 >90 days
0 Modification Permit
0 Off-Site Parking Agreement
0 Planned Community Developm,ent Plan
0 Planned Development Permit
0 Site Development Review -
D Major D Minor
0 Lot Line Adjustment O Parcel Map
2. Project Address(es)/Assessor's Parcel No(s)
l2aoo Newport Blvd NB 92663
CITY OF NEWPORT BEACH
100 Civic Center Drive
Newport Beach, California 92660
949 644-3200
newportbeachca.~ov/communitydevelopment
D Staff Approval
D Tract Map
D Traffic Study
D Use Permit -□Minor □Conditional
D Amendment to existing Use Permit
D Variance
□ Amendment -□Code □PC □GP □LCP
D Zoning Clearance~ □ADU D Use
Ii) Other.
3. Project Description and Justification (Attach additional sheets if necessary):
Patio expansion for existing restaurant
4. Property Owner's Affidavit*:. (I) (We) lsergio Avila , ,
depose and say that (I am)(we are) the ow r(s) of the property {ies) invol..,:ed in this application. (I) {We) further certify,
under penalty of perj , that the foregoi statements and answers herein contained and the information herewith
submitted are in all r pects true and ect the best of {my) (our) knowledge and belief.
Signature(s): --A~:......,.~~--,,L:f-::.~~~===-' itle: I President I Oate: ___ r _21_1_12_0 __ ~1
MM/0D/Y.EAR
Signature(s): _____________ Title: ___ I ________ ....,I Date: j1 211120 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. ,
llcnb.ldldalaVJserslCOOIShanKMll'larrilg_OMsionlAj)pllca6ons\Applieation_Gudeline5\Plamr,g Penni! Ownel's Al!ad.MI 2022.doct Rev: 07/05l22
PA2022-0283