HomeMy WebLinkAboutPA2022-044_20220217_ApplicationCommunity Development Department
Planning Permit Application
QTY Of NEWPORT BEACH
100 CMc Center Dm,e
Newport Bead!, Calforrta 92660
949 644-3200
newportbeaC:hca~
1. Check Pennits Requested:
0 ApprovaMO-Concept -AIC • 0 Lot Merger O Staff Appruva1
~ Coastal Development Pennlt O Limited Term Permit -0 Trad Map
D Waiver for De~ OtM!t,plnent D Seasonal D < 90 day [J>90 days O Trdc Sbfy
0 Coastal Residential Development O Modification Permit O Use -Of6,ar [JCcnilanaf
0 Condominium CorMnion O Off-Site Parking Agreement O .Attaaanenl ID e:xistng Use
D Comprehensive Sign Program O Planned Community Development Plan O Vaiance
0 Development Agreement O Planned Development Penm • 0 A.,em.eal {JCGde □PC []GP OLcP
0 Development Plan O Site Development Review -D Major D Minor O Olher:
0 Lot Line Adjustment O Parcel Mep
2. Project Ad~~A.ssessor's Parcel No(s) I (p(7J ~ ~-o.., B fvJ / Ofi[-1iJ-?r 14: I
3. Project 0-escription and Justification {Attach additional sheets if n .,;:
TGJ14,,f I--ip<4Wf,,Wt~+= ~, .. .-<tf~ °'f,'c...e, +o be-&t-.,uf-.J n,,fa <., s,,...._/De,,,1-.,../
T~c...f-~+. •
4. AppUcantlCompany Name I 05urfl.. PAt-A PA I
Mailing Address I 1~ ¾ ~ Pl.1 lo..b)pAlo. ~f. SuitelUrrit I I
City ' OnhMio I Statel CA I Zip ' 1a,2-I
Phone 1~~)2.79-S' 57 I Fax 1 I Email I c..bhon,J,U,~,,,4-!/. (.pJn I
5. ContadlCompany!-:!Name=:..!:::::===============.----;:::====~
Mailing Address Suite/Unit I
City State I I ZJp'i=I ====:
Phone I I Fax j I Em-ai
1
I ;========-....!:!!~==~
6. PropertyOWnerNamP-!Hme/ Gb/un9 Da/fo,1
MailingAddressl 12 4-o AIW /IJtA \S'freef Suite/Unit';::!====
cityl -s'eaff/e I state I WA · I Zle_l CJ?li:,.
Phonel 111-233 -qg~::; I Fax1 I Emalll hcal,'li,(rljr;},Y4/-,()o.com
7. Property Owner's Affidavit*: (I} (We} f/crze I c~ I,"/ ll --o~ Jfo,,,
depose and say that (I am} (we are} the owner(s) of the property Oes involved in this application. (I) (We) further
certify, under penalty of perjury, that the foregoing statements and answers herein contained and the lnfonnation
herewith submitted in all respects true and correct to the best of (my) (our) knowledge and belief.
Signature(s): C a.&c-n ntte: I Ow11er loate:I .... -o-i µ_,tJ_:,_p_o_~_aj
MMnlONEAR
Slgnature(s): ____________ Title: L..j _______ __.I Date: ... I ____ __
~ay be signed by the lessee or by en authorized agent if written euthorizeUon from the owner of record Is flied concurently with the
appfica'lion. Please note, the owner(s)' signature for Parcel/Tract Map and Lot Line Adjustment Application must be notarized.
PA2022-044
~riff~;:_J Worksheet ~or Combo Building & Solar Permit Application
D coinm'I.. IJ Residential City of Newport Beach -Bunding 0MsJon
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
._·p sulldi~~ □Grading . [J>ralnage DEiee -OM~ch □Plum CuYdcarD C.UTdRI □
• Project Address ~Not malling address) O Flood O Are O _Uq O Landslde C,,,A·· ~ ~ No · I 61>1-"E &ti~ blvd·. · J .1 ·I'D
Description of Work ··• u.QCmstrn,eQ
,su.tesCJ flh'tsOfllesQ l -~==~====~=.===:==========::::::::::========-YarnlanS
New/Add_SFj,_ __ ___, Remade SF!._----'-•_,· j Garagl!/New/Add .._l · __ __,
OWNBl'5 ~ Last I lj;) J fon · · I Fnt L-! • !...!.Ha::.:..:z=e;;.....l ,.,---"--___ __.I -
APPUCANl"SN_AME .__ _ _,___--....:....___;,__~-I ~ust .... l ---=----------'
'---::..-=--=--=--=--=--=--=--=--=--=--=--=--=--=--=--=-,---=--=--=----··=' -~-,. ~ ..... l· _____ ____.·1 1· .. .-1-Zip:1 ::::.-.;;--l--"!'•-phana----;::.__I·=_=_=_=_=_=~::::::.-',----~
~ NAME
~ Adlhsa
Last L-1 _ _.,:_ ___ ___.---I ~,-: --I Uc.No.(.___·._· _ __.
~ E-mal Adlhss_-
L_-:.-=--=--=--=--=--=--=--:::.-=--=--=--=--=--=--=--=--:-=----;.."'.:..-:...-_ _;_......,--' ClyL..' ___ a____, Sta L--1 ~---,.Zip __ , _ ____. Telephone~'-~____.· I .
e«ilHEBl"S LastL-f ·_.a--,,__-----·~-1 Fnt ..... l __ ___,
_Englneer'a E-mail Addl9ss
Uc. No~'-,---,..---'· j
L..--';..-=::..-:...-:...-:...-_-_-_-_-_-_--:._-_-_-_-_,---.... -..:--..:::~
Cily .__I _____ ___.I ~ .__I. ~' Zip ....... 1-____ I , Telephone ...... ,_·_· --
. . .
COHTRACTOR'S NAME/COMPANY . . Uc. ~o. ._I ___ I, ClassLJ L-------------'
Contractor's E-mail Adctess .. "•
City .....,._ ______ ___. State .._I _ __,j Zip .._I __ __,I _ Telephone.._! ___ __,
SETBACKS REAR SETBACKS FRONT ----
SETBACKS LEFT .. ·----SETBACKS RiGHT
USEZONE DEVELOPMENT NO
----------
PERMIT NO.
PLAN CHECK NO.
PLAN CHECK FEES S . __________ .,,.... __
PA2022-044
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:
________________________________________________________________________________________
PA2022-044