HomeMy WebLinkAboutPA2022-131_20220617_ApplicationCommunity Development Department Planning Permit Appl.ication
1.Check Permits Requested:D Approval-in-Concept -AIC # D Lot Merger Iii Coastal Development Permit D Limited Term Permit -
D Waiver for De Minimis Development D Seasonal D < 90 day 0>90 days D 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
2. Project Address(es)/Assessor's Parcel No(s)12036 Galaxy Dr, Newport Beach, CA 92660 APN 117-605-02
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D Staff Approval D Tract Map D Traffic Study D Use Permit -□Minor □Conditional D Amendment to existing Use Permit D Variance □Amendment -□Code □PC □GP □LCPD Other:
3.Project Description and Justification (Attach additional sheets if necessary):Construct a new 343sf ADU unit In lhe front a,ea OI the Property• along Galaxy Dr. While the lot is considered ,iitlt development• area as defined by the City the proposed u� Is in Ille l1on1 ol the IOI, away from the bluff
. !David Salene I 4.Apphcant/Compa:_::n'..l.y....:N.:.:a:.:.m.:..:.::.e.:::::================================,------;::::===========i'12036 Galaxy Dr J Mailing Address Suite/Unit ';:=:=============1City !Newport Beach State !CA I Zip 192660 I1714-745-6546 J J . ldsalene@pacbell.net J Phone .,____ ________ ____, Fax .,____ _____ ____,_ Email ,____ ______________ _,J_ !Same as above J 5.Contact/Compan y,-::.N:.:a:=..:m�e:....:::==================================,------;::::===========i'Mailing Address Suite/Unit ';::::=============ii City '---;=========================,----;::::============:'.__S�tate '----;::::::==============--1 .....:z:::.:i�p-==============:I
Phone ,___ ________ __, Fax .,__ _____ ___.I Email ,____ ______________ _,J !Same as above J 6.Property Owner N .... a_m_e_�_-_-_-_::-_-_-_-_-_-_::-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-..=-----�-=--=--=--=----_-_-_-_-_-_� Mailing Address Suite/Unit ';=:============='.I
City '---;;:=:======================,----;:::============:__�State '----;::::=============-I ___:Z:::.:i�p-==============:I
Phone'----------� Fax ,___ _____ ____.I Email ,____ ______________ _,J !David Salene 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 penalty of perjury, that the foregoing statements and answers herein contained and the information herewith itted are in all res ects true and correct to the best of (my) (our) knowledge and belief.
Signature(s): ���:::ii��===��:::::=_ __ Title: I G AJN lJOR-I Date: I 6-/7-Z"Z--I
MM/DD/YEAR
Signature(s): _______________ Title: .,____ _________ _,J Date: .,__ _____ -JI
*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.
l:\Users\CDD\Shared\Admin\Plannina Division\Aoolications\Aoolication Guidelines\Plannina Permit Aoolication 2021.docx Rev: 01124117
PA2022-131
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:
________________________________________________________________________________________