HomeMy WebLinkAbout2665 Jefferson St; ; 62-4166; PermitAPPLICATION FOR Bu tJ DING PERMIT 4166
CITY OF CARLSBAD -BUILDING INSPECTION DIVISION CJ PHONE PAtkway 9-IIBI -Ed. 36
Owner Name ... -.f.R.ew .. e ... tf-1-.......... /;J. ... ~ ................. C. .............. Mailing Address ;; b C.J.-.. .
( Ple11sB Print) ( L11st) [First) ( Middle) Number Phone
Contractor .......... ~·-······························-··········-··············-Mailing Address ....... S. ...................... .
( Ple11sB Print) Number Street City Phone
To Construct D To Add D To Alter D To Repair D To Convert D To Move From~··············································-
Type of Const.~Kind of Foundation ...... ~.!... ... No. of Stories ....... /. .. To Be Used for .d.£~~.~
Floor Space ~;r;::o~:s;::·st::~:on (sq. feet) ........... ~ .. V. . .7 ............. Const. Valuation l7-ld .... ~.c: .. '..~~: .. :~:'.~.~.--~~.e~~: .. ~:.~:~: ... ~.'.~:'. .... .
attec:hed D
Floor Space of Garage (sq. feet) ····-··········································· detached OConst. Valuation $ ....................... -.......................................... ·-··-·····-············ .. ··--
LEGAL DESCRIPTION Lot ·slo~k Subdivision ....
or ···········---·······--························:::::~···· ..... -·-·················································Section .... , ... -........ _····-tJ········ Township ............................ Range .......................... .
Loootod ,t _,2__4.,f.;,f;.?JH j • -i,,°, ----------------------------------------St"ot, Nm ____ p.,.a_..~-----------------------------------------
LAND AREA ...................................... NUMBER OF EXISTING DWELLINGS ON PROPOSED BUILDING SITE .................................................... {INDICATE
:~~,IT~~~;ND LOY~t'.~-~---~N PL~~-~~ILL THIS CONSTRUCTION INCLUDE ANY PLUMBING INSTALLATION, ALTERATION, OR
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 a check is tendered for payment of the above fee and the check is
not honored when presented for payment, your Building Per(llit will be
immediately revoked.
SIGNATURE OF
PERMITTEE .
Front Yard Set Back ......................................... ,. .......................... .
-1
Side Yard Set Back ........ ········-·····M.L.A/._, ................ .
Driveway Permit Required Yes ( No ( ~Fee ·······-··························· ..
Grading Permit Required Yes ( I No~ .................................................. .
Rear Yard Set Bad ..... LO .... :. ................ ~---····················· Sewer Disposal Plant Capital Cont. Fee ..................................................................... .
Distance Between Bldg ............ :-::'.': ............................................. . Sewer Pumping Station Capital Cont. Fee ·············-·································-············· ..
Off Street Parking Spaces ........................................................... . Sewer Main Line Cost ....................................................................................................... .
Sewage Disposal Sy.tern ········-········································· .. ··········· Sewer lateral Connection Charge ···-··········-··-·-···························-····················--······
Zone • Residential ( / J ........................................................... . Water Stocked lands Charge ......................................................................................... .
Zone • Commercial l ···-··-··-········ ·······-······-········--·····---· Water Main Pipe Line Fee .... ·························································-··········-··················
Variance Water House Service Charge ···-·····················································································
Eng. Cheek By ............................................................................... . Water Mater Charge ·······-·-·············-·-···········-·-··-·· ................................................ .
Sub Total ..................................................................................... .
Plans Approve~···f'~···,n·····J"'···············-···--············--···············-···Pl~n ,Cheek F~e ···············=·~··C,····--··--····· .. ································-··-···-············
Approved by .>.~ .. ~ ... '. ... CJ..4:2.~ .................... Build1n9 Permit Fee .. ~ .. . ................................................................... -.... .
-~ d0
Date ....... ;;2 .. -,:iiil.3 .. -41:? ... Z--:: ... -....... -.............................................. Total Charges .......... ~---·····························-······-···························