HomeMy WebLinkAboutCD 16-04; WALLACE RESIDENCE; Administrative Permits (ADMIN)CITY OF CARLSBAD APPI \TION FORM FOR CONSISTENCY DET' "NATION APPLICATION
PROJECT NAME:
Assessor's Parcel Number(s):
Description of proposal (add attachment if necessary):
Would you like to orally present your pll'oposal to your assigned staff planner/engineer? Yes No D
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):
MAILING ADDRESS:
CITY, 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 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
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APPLICANT NAME (Print): 0 \A}\() fJ:
MAILING ADDRESS: -------------------------CITY, STATE, ZIP:
TELEPHONE:
EMAIL ADDRESS:
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.
SIGNATURE DATE
APPLI~NTSREPRESEN~TIVE~rinQ: +~~\~l~JO~P~~~~----------------------------------------~
MAILING ADDRESS:
CITY, STATE, ZIP:
TELEPHONE:
EMAIL ADDRESS:
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: ,. J }()
/).
RECEIVED BY: ( ;lzri., Oa rc,;,L
~~~~~=-~~~~---------------------------------------------
MAR 0 8 2016
City of Carlsbad
Faraday Center
Faraday Cashiering 001
1606801-2 03/08/2016 149
Tue, Mar 08, 2016 02:41 PM
Receipt Ref Nbr: R1606801-2/0049
PERMITS -PERMITS
Tran Ref Nbr: 160680102 0049 0056
Trans/Rcpt#: R0115646
SET #: CDP1320X1A
Amount:
Item Subtota 1 :
Item Tot a 1:
PERMITS -PERMITS
1 @ $448.74
$448.74
$448.74
Tran Ref Nbr: 160680102 0049 0057
Trans/Rcpt#: R0115644
SET #: C0160004
Amount:
Item Subtota 1 :
Item Total:
2 ITEM(S) TOTAL:
1 @ $720.00
$720.00
$720.00
$1 '168. '74
Credit Card (Auth# 06199C) $1,168.74
Total Received: $1,168.74
Have a nice day!
**************CUSTOMER COPY*************
City of Carlsbad
1635 Faraday Avenue Carlsbad CA 92008
11111111111111111111111111111111111111111111111111111111111111111
Applicant: WALLACE CHRISTINE
Description Amount
CD160004 720.00
3935 SYME DR CBAD
Receipt Number: R0115644 Transaction ID: R0115644
Transaction Date: 03/08/2016
Pay Type Method Description Amount
Payment Credit Crd VISA 720.00
Transaction Amount: 720.00