HomeMy WebLinkAboutPA2022-0291_20221201_ApplicationCommunity Development Department
Planning Permit Application
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100 Civic Center Drive
Newport Beach, California 92660
949 644-3200
1. Check Permits Requested:
f A 7,$2.,"').,, • Q')Yl \ newportbeachca.gov/communitydevelopment
0 Approval-in-Concept -AIC # D Lot Merger
0 Coastal Development Permit D Limited Term Permit -
0 Waiver for De Minimis Development O Seasonal O < 90 day 0>90 days
0 Coastal Residential Development D Modification Permit
D Staff Approval
D Tract Map
D Traffic Study
D Use Permit -□Minor □conditional
D Condominium Conversion D Off-Site Parking Agreement
0 Comprehensive Sign Program D Planned Community Development Plan
D Amendment to existing Use Permit
D Variance
0 Development Agreement D Planned Development Permit □ Amendment -□Code □PC □GP □LCP
0 Development Plan D Site Development Review -O Major O Minor
0 Lot Line Adjustment D Parcel Map
ij('Other:;J.A?V..
2. Project Address(es)/Assessor's Parcel No(s) ./ /.,.-~,Lr 2. Sc-v<-\-v---,_,/
3. Project Description and Justification (Attach additional sheets if necessary):
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5. Contact/Company Name I 7 U 1.J' f\.,-\J of-r./2__
Mailing Address I 2-o 4 =1 2-5~1z. fr:,,.._ A✓c_ Suite/Unit I
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City I {\) (5 I State I LA
Phone I 14~ zr i ~(ig.?Fax I Emai110J ,-_1'.
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6. Property Owner Name I <' ~ r-.__ t"-V c'.l f c.r''--I
Mailing Address I zocq ~ c .,_5g.., ~ &-i&· (_ I Suite/Unit I
City I N (!3 I State I cit I Zip I q ~e,cJI
Phone I '7 ?.j q 2.J 'f 5o~ J.. ! Email n::2s., r-,/'--if O ( <-'<-Cf.5,,1 • . G.
7. Property Owner's Affidavit*: (I) (We) ,_I __ z-=D"---'--<.J_·"-"--~ __ o+-~-~---------------'
depose and say that (I am) (we are) the owner(s) of the propert (ies) involved in this application. (I) (We) further
certify, under penalty of pe~uryP,~~ the foregoing statements and answers herein contained and the information
herewi~l>!mttlffi ar . all resv s true and correct to the best of (my) (our) knowledge and belief.
Signatur~(s): \ --Title: I -w fVJL I Oate: I.....-D-?-+)-1-1---+j-z.:-o·-z h
Signature(s): _______________ Title: '-----------~ Date:
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 concurrently with the
application. Please note, the owner(s)' signature for Parcel/Tract Map and Lot Line Adjustment Application must be notarized.
I:\User,;\COO\Shared\Admin\Plannlng_Oivision\Applications\Application_ Guidelines\Planning Permit Application_ 2021.docx Rev: 01/24/17
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PA2022-0291
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:
________________________________________________________________________________________