HomeMy WebLinkAboutPA2021-308_20211222_ApplicationCommunity Development Department
Planning Permit Application
1. Check Permits Requested:
D Approval-in-Concept -AIC # D Lot Merger
~ Coastal Development Permit D Limited Term Permit -
D Waiver for De Minimis Development D Seasonal D < 90 day 0 >90 days
0 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
CITY or 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
D Use Permit -□Minor OCond1tional
D Amendment to existing Use Permit
D Variance
□ Amendment -□Code □PC □GP □LCP
D Other:
2. Project Address(es)/Assessor's Parcel No(s)
12676 BAYSHORE DRIVE, NEWPORT BEACH, CA 92663 / APN 049-1 91-16
3. Project Description and Justification (Attach additional sheets if necessary):
I SEE ATTACHED PROJECT DESCRIPTION
4. Applicant/Company Name I SKURMAN ARCHITECTS
Mailing Address 13654 SACRAMENTO STREET Suite/Unit ';:I======',
City I SAN FRANCISCO I State I CA I Zip 194118
Phone 1415 440 4480 Fax 14 15 440 4488 I Emai l I SUZETTE@SKURMAN.COM
C t tic N I SUZETTE SMITH / SKURMAN ARCHITECTS
5. on ac ompan,_y~a~m~e-==================;------,=======i
Mailing Address 13654 SACRAMENTO STREET I Suite/Unit ';:I =====;
City I SAN FRANCISCO I State I CA I Zip 194118
Phone 1415 440 4480 Fax I 415 440 4488 I Email I SUZETTE@SKURMAN.COM
P rt O N Is BAYSHORE PARTNERSHIP, LP
6. rope y wner ~a~m~e-====================,-----;::::=====::;'
Mailing Address j 5100 CAMPUS DRIVE Suite/Unit I STE 300
City I NEWPORT BEACH State I CA I Zip 192660
Phone 1949 233 111 1 I Fax ~-----'' Email I JLANGSON@IBG-USA.COM
7. Property Owner's Affidavit*: (I) (We) I a BAYSHORE PARTNERSHIP, LP
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 re~ects true ard correct to the best of (my) (our) knowledge and belief.
8> ~$\,\Ore Va.rtl)~~'f L.f.
1
,-----.
Signature(s): : l~~h.~t t?ui l~,f\ QIVl.l Title: lowNER Date: I 1011212021
(lo' ~---------1 MM/OD/YEAR
ilc ;,a v---.., J itle: i o w NER I n ate: I 10/12/2021 Signature(s):
c "" • tt"9' ""' , r~•
*May be signed by the lessee or by an authoriz°t!d 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.
l~Users\COO\Shared\Admln\Plann,ng_DMsion\Appllcntions\App0callon_Gu,delines\PlaMong Pennh Appllcalion_2021.docx Rev: 01/24/17
PA2021-308
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:
________________________________________________________________________________________
PA2021-308