HomeMy WebLinkAboutCD 16-15; SQUIRES DAM COMMUNICATION SITE; Administrative Permits (ADMIN)CITY OF CARl.SBADAPPLICATION FORM FOR CONSISTENCY .. DETERMINATION APPLICATION
PROJECT·NAME: \.It" R .I .c .o:'\ = ;,..,\ 'Le I ~ON ::::;i q,\} I "t:;..';:) v,, i'"\
Assessor's Parcel Number(s); ( l:.o'1 -G,14 v 36 · 'J. .. .'31,-DZ,.
Description of proposal (add attachment if nece$sary); I[£ e, i c.ON l ~ PRoPo5, Nb TO R.tfli:OIJE-.AN.D
R.E.Pt..AC..E,. ('/) EY.t~rtN6 !t.NT~tvNll'G 1 (3) RRV'S, ADD (:i)RA-yct1PS AND (3)
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I Would yQu like to orally present your proposal to your assigned s~ff plc1nner/engineer? Yes No
Please list the staff members you have previously spoken to regarding this project. If none, please so state.
___ o-tRJS 5£'f. Tor-..J
OWN ER NAME (Print):
MAIUNGADORESS:
CITY, STATE, ZIP: cA:f?. t..wAD, cA '12.DDCo
TELEPHONE: -,~ -434 -l-~l(,
EMAi L ADDRESS:
*Owner's signature Indicates permission to conduct a preliminary
review fora development proposal.
APPUCANTNAME(Print): Vii.Kl?J>N i.,vt.l<EL~$S
MAiLINGADDRESS: t556S 5ANP CANf1>N /IY;;;:
CITY,STATE,ZIP: JRViiVE; CA q,2.b1~
TELEPHONE:
EMAIL ADDRESS:
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IN THE PROCESS Of-RcVll:.WING l Hl::S APPUCA HON IT MAY Bl::
NECESSARY FOR MEMBERS OF CITY STAFF TO INSPECT AND
ENTER THE PROPERTY THAT IS THE SUBJECT OF THIS
APPLICATION. I/WE CONSENT TO ENTRY FOR THIS PURPOSE. I
l CERTIFY THAT J AM THE LEGAL REPRESENTA rtVf;: Of-FHc l
OWNER AND THAT AL}.: THE ABOVE INFORMATION IS rRUE
AN b CORRECT TO THE BEST OF IIAY KNOWLEDGE.
CERTIF THATIAMT GALOWNERANDTHATALL THEABOVE
INFOR TION I E AN CORRECT TO THE BEST OF MY .
KNOW OOE.
1c!2v/ I<..
DATE
10/z r Jt,
DATE
ENTATIVE(Pririt}: :f/i..L CLGVELAA/v,. PLA/\JCO.dl tNC.
MAILING ADDRESS: 302.. :-s-,Are: p <-ACE
CITY, STATE, ZIP:
I TELEPHONE:
EMAIL ADDRESS:
FEE REQUIRED/DATE FEE PAID: OCT 2
RECEIVED BY:
P-16
_@f::-=-+-,,____ ____________ CITY OF CARLSBAD
PLANNING DIVISION
Pago 2 of 2
J?(?Vtf C, D ~2-
Re11iseo 08116
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City of Carlsbad
1635 Faraday Avenue Carlsbad CA 92008
llllllllllllllllllllllllllllllllllllllllllllllllllll~lilllll
Applicant: VERIZON WIRELESS
Description Amount
CD160015 720.00
3300 SUNNY CREEK RD CBAD
Receipt Number: R0121216 Transaction ID: R0121216
Transaction Date: 10/28/2016
Pay Type Method Description Amount
Payment Check 720.00
Transaction Amount: 720.00
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City of Carlsbad
Faraday Center
Faraday Cashiering 001
1630201-2 10/28/2016 149
Fri, Oct 28, 2016 12:38 PM
Receipt Ref Nbr: R1630201-2/0045
PERMITS -PERMITS Tran Ref Nbr: 163020102 0045 0056
Trans/Rcpt#: R0121216
SET#: C0160015
Amount:
Item Subtotal:
Item Total:
ITEM(S) TOTAL:
Check (Chk# 0000025922)
Total Received:
Have a nice day!
1@ $720.00
$720.00
$720.00
$720.00
$720.00
$720.00
**************CUSTOMER COPY*************
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