HomeMy WebLinkAbout1080 Palm Ave; ; 62-5037; PermitAPPLICATION FOR Bu Qo ING PERMIT 5037
CITY OF CARLSBAD -BUILDING INSPECTION DIVISION
PHONE PArkway 9-1181 -Ext. 36
Ow,or Name .ka .. e:hi..1:::Lez···t.o.,:J/11!!."'1 .... J.M.ili,g Addrm .. /.~ .. 'i!IJ ?~
(Please Print) (Last) 1Hrst) (Middle) Number Street City Phone
Co,traclor .Jv.,.e, l,{)a.h .... ~.... .... aili,g Address ~,,f.3.~ ...... e.~~ I Please Print) Number · Streei) C;,/y Phone
To Construct~ To Add D To Alter D To Repair D To Convert D To Move From··············•······~------
Type of Co,si.:;z~Ki,d of Fou,datio, ... ~.1 .... No. of Stories .... ./ ...... To Be Used ford~.~·········•
(Frame, Masonry, Etc.) (On1:1 Family Dwelling(/Store,-Etc.)
Floor Space of Proposed Construction (sq. feet) .. . .. Const, Valuation $ ....... --=======~-----------
Floor Space of Garage (sq. feet) .......... 6 .. ~.${_ ___ :::::t:~ ~-Valuation $ ...... ~ c:2 ~ ~---~-e __________ _
LEGAL DESCRIPTION ·············· Lo:A ,, :J:'&.~····{2-r,.\= ~····~···~
or _______________________ _.,action .................................... Township _________ Range ____ _
Located al .. ./C>..8.P .... P~ !reel, Near . .u1e~-----------Assigned House Number J LAND AREA ...................... NUMBER OF EXISTING DWELLINGS ON PROPOSED BUILDING SITE --~----············· (INDICATE
SIZE, USE AND LOCATION ON PLOT PLAN). WILL THIS CONSTRUCTION INCLUDE ANY PLUMBING INSTALLATION, ALTERATION, OR
ADDITION? YES __ _ NO.,.....---
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUCTION,
If II check is tendered for payment of the above fee and the check is J /) ;;~!Ji:~:i; r:!:keJ:resented for payment, your Building Permit will be SIG~:J~~f,.E~F~···7f\ ..... ~........... .. • ...... l.,.~ ... ~ ... ~ ... :::. ~=:'.'.::::::::._
~I Front Yard Set Back .........
4dld di~ d ---Driveway Permit Required Yes(✓ No I I Fee
"/' Grading Permit Required Yes I I No I I ,,
Side Yard Set Back ............... , ··········~
Rear Yard Set Back ............... 6.. .. ~ Sewer Disposal Plant Capital Cont, Fee
Bldg ... _/R._~
, I Distance Between ~ .. Sewer Pumping Station Capital Cont. Fee ..
Off Street Parking Spaces --. Sewer Main Line Cost .. \ ................
Sewage Disposal System
,...._ Sewer Lateral Connection Charge
Zone -Residential ( I Water Stocked Lands Charge
Zone -Commercial ( I Water Main Pipe Line Fee ............... ,
Variance Water House Service Charge
E,g, Check By Water Meter Charge -
Sub Total I :l,$ , ..... ~
Plans Approved by ----~··············.------------Pl11n Check Fee ··········-----------------
Approved by .. ~.": .... S..L ... (tl, ...................... uilding Permit Fee .... /;;1_, JlS:l-;;-,,··············----------
Dale ............ ~ ... '.:-: .... ¥.. ..... '.:"" (, 'L Total Charges ..... /..J.~:::;;-~:;i._"' __________ _