HomeMy WebLinkAboutCD 2022-0001; VIASAT BLOOM ENERGY FUEL CELL VIA003; Consistency Determination (CD)CITY OF CARLSBAD APPLICATION FORM FOR CONSISTENCY DETERMINATION APPLICATION
PROJECT NAME: Bloom Energy Fuel Cell -VIA003
Assessor's Parcel Number(s) and •• •
Address: 2426 Town Garden Road -2132601000
Description of proposal (add attachment if necessary): . ·
Install of fuel cell Bloom Energy servers ~ e\ c..vv, v vJ ~ \
Would you like to orally present your proposal to your assigned staff planner/engineer? Yes D·
□
No
Please list the staff members you have previously spoken to regarding this project. If none, please so state.
Edward Valenzuela
OWNER NAME (Print):
MAILING ADDRESS:
CllY, STATE, ZIP:
TELEPHONE:
EMAIL ADDRESS:
*OWner's signature Indicates permission to conduct a preliminary
review for a development proposal.
IN THE PROCESS OF REVIEWING THIS APPLICATION IT MAY BE
NECESSARY FOR MEMBERS OF CllY STAFF TO INSPECT AND
ENTER THE PROPERlY THAT IS THE SUBJECT OF THIS
APPLICATION. INVE CONSENT TO ENTRY FOR THIS PURPOSE. I
CERTIFY THAT I AM THE LEGAL OWNER AND THAT ALL THE ABOVE
INFORMATION IS TRUE AND CORRECT TO THE BEST OF MY
KNOW~
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SIG'NATURE DATE
APPLICANT'S REPRESENTATIVE (Print):
MAILING ADDRESS:
CllY, STATE, ZIP:
TELEPHONE:
EMAIL ADDRESS:
APPLICANT NAME (Print): Jennifer Horta -----------MA I LING ADDRESS: 4353 N. 1st Street
CllY, STATE, ZIP: San Jose, CA 95134
TELEPHONE: 562-332-8504 ------------~IL ADDRESS: jennifer.horta@bloomenergy.com
I CERTIFY THAT I AM THE LEGAL REPRESENTATIVE OF THE
OWNER AND THAT ALL THE ABOVE INFORMATION IS TRUE
AND CORRECT TO THE BEST OF MY KNOWLEDGE.
10-19-2021
DATE
I CERTIFY THAT I AM THE LEGAL REPRESENTATIVE OF THE APPLICANT AND THAT ALL THE ABOVE INFORMATION IS TRUE AND
CORRECT TO THE BEST OF MY KNOWLEDGE.
SIGNATURE DATE
FEE REQUIRED/DATE FEE PAID: --lt i 5 ?._ ~ 00 ••
RECEIVED BY: '--/. ~---,-/-5-J _2.D_1:-_1--_________ _
P-16 Page 2 of2 Revised 02/28/18