HomeMy WebLinkAboutPA2022-094_20220505_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: fA~oi~-o 41'i
D Approval-in-Concept -AIC # D Lot Merger D Staff Approval
D Coastal Development Permit D Limited Term Permit -D Tract Map / D 6 ~ -~CJ;;>--~
D Waiver for De Minimis Development D Seasonal D < 90 day 0>90 days D Traffic Study
D Coastal Residential. Development D Modification Permit D Use Permit -□Minor □Conditional
D Condominium Conversion D Off-Site Parking Agreement D Amendment to existing Use Permit
D Comprehensive Sign Program D Planned Community Development Plan D Variance
D Development Agreement D Planned Development Permit . gAmendment -□Code □PC □GP □LCP
D Development Plan D Site Development Review -D Major D Minor )Ol Other: ~\.,..) l,,_.
D Lot Line Adjustment D Parcel Map C,A-v/lAA A_\)~
2. Project Address{es)/Assessor's Parcel No(s) (P
I 4 t~ o Oi:: so L,~ ·-n~:. \'<...\<.{\~
3. Project Description and Justification (Attc1ch additional sheets if necessary):
I /\OU
5. Contact/Company Name I Gf-\Ht"L
Mamng Address Suite/Unit I
City State I I Zip I
Phone Fax1 I Email
6. Property Owner Name I Sl'\v\~
Mailing Address Suite/Unit I
City State I I Zip I
Phone I Fax1 I Email!
7. Property Owner's Affidavit*: (I) (We) ............... -~ ............. -.............. ____ ............................ _______ ............... __ ............... ..........._ ______ ............,.. ...............
depose and say that (I am) (we are) the owner(s) of the property (ies) involved in this application. (I) (We) further
certify, under penal•ty. of perjury,f. at the foregoing statements .. and. a. n.· s·w. er·s· h ... e.rein·c· o··n··· tained and. ·t·h···e· .in .. for.ma .. ti·o·n· herewith submitted are in all re~~f • ts true and correct to the best of (my) ~our) knowledge and belief: . _. :Z..
Signature(s): /~ tmJ;f, Title: I OLIJl--le.(2-loate: I 4~tL\ C: I
/ ----~---..____ MM/DD/YEAR I
Signature(s): ______________ Title: I Date: ...... I ____ ~ _____ ____..; ......
*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.
PA2022-094