HomeMy WebLinkAboutPA2021-125_20210528_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 Minim is 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)
13300 Newport Boulevard
CITY OF NEWPORT BEACH
100 Civic Center Drive
Newport Beach, California 92660
949 644-3200
newportbeachca.gov/communitydevelopment
D Staff Approval
D Tract Map
D Traffic Study
~ Use Permit -□Minor ~Conditional
~ Amendment to existing Use Permit
D Variance
0 Amendment -□Code □PC □GP OLCP
D Other:
3. Project Description and Justification (Attach additional sheets if necessary):
Attachments: "A" -Project Description & Justification; "B" -Examples of Level 1 and 2 Events; "C" -Noise Mitigation Report
A I. t/C N !Anthony Wrzosek/R.D. Olson Development 4. pp 1can ompa~n~y~~a~m~e~===================================,------;:==========:::::::.
Mailing Address ls20 Newport Center Drive Suite/Unit ';:::16=0=0======.
City I Newport Beach State l cA I Zip 192660
Phone 1949-271-1109 I Fax~------~' Email lanthony.wrzosek@rdodevelopment.com
C t tic N l~nthony Wrzosek/R.D. Olson Development
5. on ac ompan,_y~a~m~e:....:::===================i,-----;:::=====::::::;'
Mailing Address ls20 Newport Center Drive Suite/Unit ';::'6=0=0========~
City !Newport Beach State lcA I Zip 192660
Phone 1949-271-1109 Fax -------~' Email lanthony.wrzosek@rdodevelopment.com
0 N I city of Newport Beach
6. wner ame '-----;::::=======================;--------;=======:
M .1• Add I 100 Civic Center Drive S •t /U ·t I a, mg ress u1 e m ';::::======::::;
City I Newport Beach State ~lc_A-;::======='~Z~i'.!:p'.....:I=92=6=6=0======:
Phone 1949-344-3309 I Fax'----------'' Email'---------------~
7. Property Owner's Affidavit*: (I) (We) ,_IR_.o_._0_1_so_n_D_e_v_e1_o_pm_e_n_t _________________ ~
depose and say that (I am) (we are) the owner(s) of the property (ies) involved in this application. (1) (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): ~. ~ Tltle• 1 };;iJz /p./;.;/GJ I Date· I% C '..i~ \ /~ _ y 6 D/MON€AR
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 the
application. Please note, the owner(s)' signature for Parcel/Tract Map and Lot Line Adjustment Application must be notarized.
F:\Users\CDD\Shared\Admin\Planning_Division\Applications\Application_Guidelines\Planning Permit Application • CDP added.docx Rev: 01/24/17
PA2021-125
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:
________________________________________________________________________________________
PA2021-125