HomeMy WebLinkAboutPA2022-086_20220419_ApplicationCommunity Development Department
Planning Permit Application
1. Check Permits Requested:
O Approval-In-Concept~ AIC # D Lot Merger
O Coastal Development Permit D Limited Term Permit -
O Wah/or for De Minimis Development O Seasonal O < 90 day 0>90 days
0 Coastal Residential Development D Modification Permit
0 Condominium Conversion O Off-Site Parking Agreement
D Comprehensive Sign Program D Planned Community Development Plan
0 Development Agreement O Planned Development Permit
0 Development Plan O Site Development Review -D Major O Minor
0 Lot Line Adjustment O Parcel Map
2. Project Address(es)/Assessor's Parcel No(s)
100 Civic Center Drive
Newport Beach, California 92660
949 644·3200
newportbeachca.gov/communitydevelopment
D Staff Approval
D Tract Map
D Traffic Study g Use Permit ~lnor OConditJonal
D Amendment to existing Use Permit
D Variance □ Amendment -□Code □PC □GP □LCP
D Other:
j 3349 f. Coa.~-1 Hijhv..lU.:J U)rGr\O.. DeJ.. . .M,o..r CA ~ 2G2.S
3. Project Description and Justification (Attach additional sheets if necessary):
I C.e,ffee Sh.op
4. Applicant/Company Name I R f'lf"B LL-C I
Malling Address I 4810 Porte__ lJe.uJp::>rt I Suite/Unit':============!,
City! 'NMpor+ T,a..ad.1,... State! CA l Zlpl '1 2 "60 l
Phone I 'l4C\ bly. 5).1_ 15 Fax ...... ! ___ ___.I Email I ('<:l~fondb@9MaiL(O/v\ !
I R -F-1>fs L-L-G I 5. Contact/Companyt-:.:.N:=a.:.:m:.::e..===::::::=================================::::;------,.....=-=-=-=-=--=-==-=-=:::;'-
Maillng Address I 4 ~ lo Park. NluJ()Jri-Suite/Unit';:...-:::..-:::..-:::..---=------_ __,
City I N tu..PJr+ ~~~
Phone ij ~1 6 ·14 ~ 2. lS
State I CA I Zip\ 9 2..Gbc:>
I Fax=--1 ___ __,I Emanl ruy-~db@ 901aJf.CO\.A
I Esw-.0..1 el \)oo,tW\o..rd I S\.\ci\o. \)oo~-lw\Qrct 1·.
6. Property Owner N,;:.a~m~e~===:===:==============================ii----;:::========::=;-1"
MalllngAddressl ).\l.8 Po,.\-t)urV\es~ Sulte/Unlt-;=:=========::==:,I
City I N twporr 'l>to..c.k.. State! r-_C_k ___ -11 Zip I '\ 'Lb e, 0
Phone j q 'i <\ b '>1 <, ~ 1 ei I Fax .:-.J ___ ___,j Em_a_il r===========~~=========~
7. Property Owner's Affidavit*: (I) (We) .,___--:-~-:-------------------_j
depose and say that (I am) (we are) the owner(s) of the property (las) Involved in this application. (I) rt,/e) further
certify, under penal of perjury, tha foregoing statements and answers herein contained and the information
herewith submi a in all res d correct to the best of (my) (our) knowledge and belief.
Signature{s ·~~--H-~~-----Title: I Ow ) rJ E 42_ j Date: 11---IC~-c2.:/{
MM/DONEAR
Signature(s): _____________ Title: '---------~_j 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.
PA2022-086
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:
________________________________________________________________________________________
PA2022-086