HomeMy WebLinkAboutCD 15-11; Carlsbad Technology Inc Ramp; Administrative Permits (ADMIN)CITY OF CARLSBAD APPLICATION FORM FOR CONSISTENCY DETERMINATION APPLICATION
CITY USE ONLY
Project Number:
Would you like to orally present your proposal to your assigned staff planner/engineer? Yes D No 0
Please list the staff members you have previously spoken to regarding this project. If none, please so state.
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OWNER NAME (Print): W e-J _ Yu k\ C\ L£ e, APPLICANT NAME (Print): 5 ~\ (;o..A.:;i
MAILING ADDRESS: StfL'L pP'l.$ -:viYV£~ fpuvi 5,1)-(el<:~ MAILING ADDRESS: S122-ft~..t'[AS M•v..U.. &vvt.<in'-te r 2_
CITY, STATE, ZIP: C.ccvA hcwl , M, q L. 00 g-CITY, STATE, ZIP: ;; tVv-f., bcvJ.. , (A q 2-0 <J 5,<
TELEPHONE: 7{o 43 j K2.. <;±Lf i 1 0 6 TELEPHONE: 76-o _ =t-3 i -&-:z_ [fq-g .. ~ /S
EMAIL ADDRESS: we(-YvVI5·· ue@Ct:vvAlxJ-&..clwtu&rr: Jvt~~~.!~\DRESS: 5 B tLO@ C,w!s!J=ulvkt,.to~Cj :J r'K-.. ifVVl
*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 CITY STAFF TO INSPECT AND
ENTER THE PROPERTY THAT IS THE SUBJECT OF THIS
APPLICATION. 1/WE 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 KNOWLEDGE. SIG~6::...>-•-~
APPLICANT'S REPRESENTATIVE (Print):
MAILING ADDRESS:
CITY, STATE, ZIP:
TELEPHONE:
EMAIL ADDRESS:
f:JV/u )/,,C
DATE
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.
I CERTIFY THAT I AM THE LEGAL REPRESENTATIVE OF THE APPLICANT AND THAT ALL THE ABOVE INFORMATION IS TRUE AND
Cs: TO THE BEST OF MY KNOWLEDGE. ~ ~ e~tr/a·?lls-
SIGNATlJRE' DATE '
FEE REQUIRED/DATE FEE PAID:
RECEIVED BY:
:\? BV \ l 0 "~·'6
P-16 Page 2 of2
r~iCO (D U'l Revised 09/14
City of Carlsbad
Faraday Center
Faraday Cashiering 001
1509301-1 04/03/2015 32
Fri, Apr 03, 2015 03:36PM
Receipt Ref Nbr: R1509301-1/0011
PERMITS -PERMITS
Tran Ref Nbr: 150930101 0011 0014
Trans/Rcpt#: R0108119
SET # : CD 150011
Amount:
Item Subtota 1 :
Item Tot a 1:
1 @ $707.00
$707.00
$707.00
ITEM(S) TOTAL: $707.00
Credit Card (Auth# 011530) $707.00
Total Received: $707.00
Have a nice day!
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City of Carlsbad
1635 Faraday Avenue Carlsbad CA 92008
llllllllllllll~lllllllllllllllllllllll~ll~llllllllllllllll~ll
Applicant: GAO SONG
Description Amount
CD150011 707.00
5922 FARNSWORTH CT CBAD
Receipt Number: R0108119 Transaction ID: R0108119
Transaction Date: 04/03/2015
Pay Type Method Description Amount
Payment Credit Crd VISA 707.00
Transaction Amount: 707.00