HomeMy WebLinkAbout1870 BUENA VISTA WAY; ; 63-5448; PermitAPPLICATION FOR B u 1 # 11 4 PERMIT
Sewer Pumping Station Capital ant. Fee .....................................
Sewer Main Line Cost .......................................................................................................
Sewer Lateral Connedion Charge ...................-..-.............. ............
Water Stocked Lands Charge .........................................................................................
5448
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CITY OF CARLSBAD - BUILDING INSPECTION DIVISION
PHONE PArkway 9-1181 - Ext. 36
Owner Name ____E/ .. &..<...-- .... D..A-.&f: .................................. Mailing Address lg7.!!...L.& .... /& ....... "A,
(Please Print] (Last) (First) (Middle] Number Street City Phone -
Contractor .$&&biirC ..... + .......... g.4 ..... ...- Mailing Address ~~+.~~...~.~~~..~~~..~.
ease Print) Number Street city Phone
To Repair 0 To Convert 0 To Move From .............................................................. lo Address To Construct 0
Type of Const.3/1..-nd of Foundation .....
To Add 0
..... N 0. of Stories ..... [ ........ To Be Used for ..... EA..?..&&.. - (Frame, Masonry, Etc.) (One Family Dwelling, Store, Etc.) 6-0
Floor Space of Proposed Construction (rq. feet) .......... +.<k .............. Const. Valuation $ .... &...f.@.c.: ............................................................ I ....._
Water Main Pipe Line Fee ............................................... .
aftached 0 ...................................................... Floor Space of Garage (sq. feet] ................................................. detached OConst. Valuation $ ...................... ............._._....
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LEGAL DESCRIPTION ................................................................................... ........_..............................*............... ......................................................................................... Lot Block Subdivision
or ...................................................................................... ........................................ Section .................................... Township ............ ...... Range ..........._......_.- ....
Located at ................................... Assigned House Number str~et, Near
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 ................
1 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 a check is tendered for payment of the above fee and the check is
not honored when presented for payment, your Building Permit will be immediately revoked. PERMITTEE ....................... SIGNATURE OF
I II
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Zone . Residential (
Zone - Commercial (
Variance
Eng. Check By .....................................
) ............................................................
) ...............
....................................................................... .. Plans Approved by Plan Check Fee ....-........ 95"
Approved by ..... .Building Permit Fee ..... L..g .................................................................................
Total Charger .../-.g...- ......................................................... -..-- &@ .................................... Date ......