HomeMy WebLinkAboutPA2022-041_20220211_ApplicationCommunity Development Department
Planning Permit Application
CITY OF NEWPORT BEACH
100 Civic Center Drive
Newport Beach, California 92660
949 644-3200
newportbeachca.gov/communitydevelopment
1. Check Permits Requested:
D Approval-in-Concept -AIC # O Lot Merger
D Coastal Development Permit O Limited Term Permit-
□ Waiver for De Minimis Development O Seasonal D < 90 day 0 >90 days
D Staff Approval
D Tract Map
D Coastal Residential Development D Modification Permit
D Condominium Conversion D Off-Site Parking Agreement
D Traffic Study
]ii( Use Permit ~Minor □Conditional
D Comprehensive Sign Program D Planned Community Development Plan
D Development Agreement O Planned Development Permit
D Amendm~nt to existing Use Permit
D Variance
D Development Plan O Site Development Review -□ Major O Minor
D Lot Line Adjustment D Parcel Map
□ Amendment -□Code □PC □GP □LCP
0 Other:
2. Project Address{es)/Assessor's Parcel No{s
'1.ll6 Ne..wport: ~\\re\ l'\e..w orr Q,-<-o..c.1'., c_p S"';)--e.....C-
3. Project Description and Justification {Attach additional sheets if necessary):
I
4. Applicant/Company Name I \Z.u Lr-r ~ f=-1.,1_c:.., I
Mailing Address I l 4...S:-!J-D fo.?i)€-Ac..t'e.S Lr, · Suite/Unit';::I ========~'
City I Tr" •.~ e-, I State I LA I Zip I q .2-60 ½ I
Phone I q_ 4 °t-33 l-½ 1 O I Fax I I Em.,_a_il .=====~~::::::::::=:=======~
6. Property Owner Name I G u.(pre..u ~' ~a-~ I
Mailing Address I l 4~})-0fet!'1)~ P,c..r~ '-"'' Suite/Unit I I
City L·r;:f\) ,l"e_., I State I L-lt I Zip I q J-6° Lr I
Phone I q lt.°t-<)2> l---½,u l I Fax I I Email l~l..4r pre.d:Se-t~~~IA·m~ ju, r1l
7. Property Owner's Affidavit*: (I) (We) ~I l,,.,__U-'-R'---Pf-'£.~t::.__1---=----------'7--"--'1,..:..::AJ....;:b;__H __________ _
depose and say that (I am) (we are) the owner(s) of the property (ies) involved in this application. (I) (:Ne) 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.
Slgnature(s): jJ ~ Tille: ....... 1 C:...::....;Co~---------ll Date: I Z/ZIZPY I
Signature(s): --------------Title: LI _________ .....JI Date· I MM/DD/YEAR I
*May be signed by the lessee or by an authorized agent if written authorization from the owner of record is filed con~rrenUy with the
application. Please note, the owner(s)' signature for ParceVTract Map and Lot Line Adjustment Application must be notanzed.
L\UeenlCOOIShare<Md'ninlPlamino OivislonlADoic:ationslADokation Guidelines\Plamina Parm~ ADolicalion 2021.docx Rev: 01124/17
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PA2022-041
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:
________________________________________________________________________________________
PA2022-041