HomeMy WebLinkAboutPA2021-007_20210121_ApplicationCommunity Development Department
Planning Permit Application
1. Check Permits Requested:
D Approval-in-Concept -AIC # D Lot Merger
D Coastal Development 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)
215 ~'1-t"-5f. I\Jtwfoll--\-'3tA-C..h
p ~-bi"/;O~r~Ef;i
100 Civic Center Drive
Newport Beach, California 92660
949 644-3200
newportbeachca.gov/communitydevelopment
D Staff Approval
D Tract Map
D Traffic Study
D Use Permit-DMinor □Cond_itional
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):
/I I I ' . ,.L. AD\, I COVIV,tl"°']t""' c,r e,ti">"li,t'.J 5~'j' 5f''rl( NTV v
I AA -l-\--SM,;~ I 4. Applicant/Compa~n'..ly..!N~a~m~e:..::=='== v•=tA===========================,------;:::::::::=======::.,
Mailing Address I '-{'1( 0 t O N-tw fc>l"ll-e, 1"~ Suite/Unit ';:I =======::::::::::I
City I Al' w f<J r ./--lj I Ac:,~ ] State -, _C_4 ____ 1 Zip I 7 L (," 3 I
Phone j ql{'1 88? ~z (, 3 Fax,_! ____ ___.I Email J f>1<>,.H, su bf,mt @~,.,,llo~l.co11-1 ]
5. Contact/Com pany~N:.::::a.::m:::e:...::l====s=· A=1£1==e===========================.------;=========:=::;"'
Mailing Address Suite/Unit ';::j =========::;]
City -'-;:::::::::::::::::::::::::::::::::::::======.---;::::::::::::===::::::...~State '---;:::::::::::=:::::::::======-1......::::zi:.i::P..:::.I =========;I
Phone~' -------~~I Fax ______ ~I Email---------------
6. Owner Name ~-;::::::::::::::::::=S::::::A=M==(============================i----------;============:
Mailing Address Suite/Unit ';:I=========::::::::::
City '---;;::::::::================::;----;::::=============--~State .__-;:::::===========:::::::.1-..::z::=.iiPt::..::::=============:
Phone l Email ~1-------------~
7. Property Owner's Affidavit*: (I) (We)-•'---~------------------~
depose and say that (I am) (we are) the wner(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.
Signature(s): ,JJ{~.nf.,,.... ,h Title: [ IJIJ<JNttL I Date: l 11/!1 /zo_io_~ ~ '-"ritMO/YEAR
Signature(s): _______________ Title:,__ _________ _, Date: ,._j _____ _____,
*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.