HomeMy WebLinkAboutCD 11-01; Moonstone Levatino; Administrative Permits (ADMIN)•
PROJECTNAME: M Ob"'"'.S b"'-e / ~.v .. '\-i~.-,:,
I Assessor's Parcel Number(s): ·z. t.S ·-0 5o . 7 3
Description of proposal (add attachment if necessary):
Would you like to orally present your proposal to your assigned staff planner/engineer?
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.
I CERTIFY THAT I AM THE LEGAL OWNER AND THAT ALL THE
ABOVE INFORMATION IS TRUE AND CORRECT TO THE BEST OF
~ 1/26j(\ MY~~N~.WL~ GE. . I
SIGNAT RE DATE '
APPLICANT'S REPRESENTATIVE (Print):
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
APPLICANT NAME (Print): S "'\ ~ c._ .s Ch-'-<-......-~--~~~----------~-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. ~ -/,_~/! slji~ATURE DATE '
C\TY OF CARLSBAD
PLANN\NG DEPT
IN THE PROCESS OF REVIEWING THIS APPLICATION IT MAY BE NECESSARY FOR MEMBERS OF CITY STAFF TO INSPECT AND
ENTER THE PROPERTY T TIS THE SUBJECT OF THIS APPLICATION. 1/WE CONSENT TO ENTRY FOR THIS PURPOSE.
FEE REQUIRED/DATE F.........-.,...,...,Ll.l
RECEIVED BY:
P-16 Page 2 of2 Revised 07/10