HomeMy WebLinkAboutPA2022-0215_20221005_Discretionary Application Owners AffidavitI I • i
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Community Development Department
Discretionary Application
Owner's Affidavit
CITY OF NEWPORT BEACH
100 Civic Center Drive
Newport Beach, California 92660
949 644-3200
newportbeachca.gov/communitydevelopment
1. Check Permits Requested:
D Approval-in-Concept -AIC #
D Coastal Development Permit
D Waiver for De Minimis Development
D Coastal Residential Development
D Condominium Conversion
D Comprehensive Sign Program
D Development Agreement
D Development Plan
D Lot Merger D Staff Approval
D Limited Term Permit -D Tract Map
D Seasonal D < 90 day 0>90 days D Traffic Study
D Modification Permit D Use Permit -□Minor □Conditional
D Off-Site Parking Agreement D Amendment to existing Use Permit
D Planned Community Development Plan D Variance
D Planned Development Permit D Amendment -□Code □PC □GP □LCP
D Site Development Review -D Zoning Clearance _ □ADU □ Use D Major D Minor
D Lot Line Adjustment ~-Parcel Map D Other:
2. Project Address(es)/Assessor's Parcel No(s) .
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3. Project Description and Justification (Attach additional sheets if necessary):
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4 . 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) f'Ne) further certify,
under penalty of perjury, that the foregoing statements and answers herein contained and the information herewith
submitted are in all respects true an orrect to the best of (my) (our) knowledge and belief.
Signature(s): --~~-"""'""S_,.-2=~~~~-=--=--=-~~===---Title: I /--1-ArV,:t-{'--Vb 1"'-t.cxff..el Date: I
Signature(s): _______________ Title:,___ _________ __, 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.
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PA2022-0215