HomeMy WebLinkAboutPA2021-110 - 20210507_ApplicationCommunity Development Department
Planning Permit Application
1. Check Permits Requested:
D Approval-in-Concept -AIC # D Lot Merger
[ii 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. ~re>ject Addf~~~(~s /As!;~S~e>r'~ Parcel No{~l
3906 River Ave APN: 423-303-04
?AJD,t-110
CITY OF NEW@E'~ ' 100 Civic er/Jri,
Newport Beach, Cali ornia 92660
949 644-3200
newportbeachca.gov/communitydevelopment
D Staff Approval
D Tract Map
D Traffic Study
D Use Permit -□Minor □'conditional
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):
demo existing single family residence construct new 3 level single family residence with attached 2 car garage
5. Contact/Compan Name f \/\lilli~~ G~id~r~ .
25 30th Street Mailjng Address
City lf\Je"'-'p~rt l3e~ch
Phone }{~~~)~?~~?~?~ ..
6. Property Owner Name j~i<?~~~~ ~~~~r"l .. I
Mailing Address l~~O{l ~iver .Ave l Suite/Unit L I
:::~:R~f ~72:~~~;15 .. I Fax r:::: ·1 sr;~:jrr;s~n@rrinl:~;~192
~~
3
1
7. Property Owner's Affidavit*: (I) (We) !Ri~h~rd R~~~~ : .:··· 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 perjury, that the foregoing statements and answers herein contained and the information
herewith submitted%: a~pects true and correct to the b. e~t ~f(lll···y······)····.(.·.o ... u.·.·.r .. ) .. k··n······o·· w.··.·.··.le····d· g···e·····.a.·.·.··.nd belie·-··f·······-· ____ ........_,
Signature(s): -~~/4 ~~ Title: Jowner . . I Date: J4-/~ -3-,
MM/DD/YEAR
Signature(s): Title: -' -· --------............ J Date: ..... 1----.................. -----------,-----
*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.
I :\Users\CDD\Shared\Admin\Planning_Division\Applications\Application_ Guidelines\Planning Permit Application_2021.docx Rev: 01/24/17
PA2021-110
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:
________________________________________________________________________________________
□ □
□
□
□
□ □ □
PA2021-110