HomeMy WebLinkAboutCD 15-16; BRESSI RANCH FOOD MART; Administrative Permits (ADMIN)·--~--~-·---~----------------------------------
CITY OF CARLSBAD APPLICATION FORM FOR CONSISTENCY DETERMINATION APPLICATION
CITY USE ONLY
Project Number:
PROJECT NAME: ~~
Assessor's Parcel Number(s):
Description of proposal (add attachment if necessary):
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Would you like to orally present your proposal to your assigned staff planner/engineer? Yes 0 No fi
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.
IN THE PROCESS OF REVIEWING THIS APPLICATION IT MAY BE
NECESSARY FOR MEMBERS OF CITY STAFF TO INSPECT AND
ENTER THE PROPERTY THAT IS THE SUBJECT OF THIS
APPLICATION. 1/VVE CONSENT TO ENTRY FOR THIS PURPOSE. I
CERTIFY THAT I AM THE LEGAL OWNER AND THAT ALL THE
ABOVE INFORMATION IS TRUE AND CORRECT TO THE BEST OF
MY KNOWLEDGE.
SIGNATURE
APPLICANTS REPRESENTATIVE (Print):
MAILING ADDRESS:
l CITY, STATE, ZIP:
TELEPHONE:
EMAIL ADDRESS:
DATE
APPLICANT NAME (Print): 'b-4 /~
MAILINGADDRESS~l/J~
CITY, STATE, ZIP: ~ ~C ~
TELEPHONE: ( ~-~) 8'ZJ -£)'"' z:S t:f~ laS
EMAILADDRESS: /Ga. t.-nak ~'?:_(). (£ .
o/MAJ(,
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.
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DATE 1
REPRESENTATIVE OF THE APPLICANT AND THAT ALL THE ABOVE INSCJ~:.a~\~ TRUE AND
NowLEDGE. ~YA§.Y CITY or-CARLSBAD ~~=-=~~~-----DATE~..:. PLAI~i~.;-.iG DIVISION
FEEREQUIREO/OATEFEEPAID: ~-~~0-~~~~~~-~~~~~-~·~~~~~~~~~~~~~~
RECEIVEDBY: ~~
P-16 Page 2 of2 Revised 09/14