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HomeMy WebLinkAboutCD 2017-0007; HULSE ORTHODONTICS MEDICAL OFFICE; Administrative Permits (ADMIN).a•••v •••-••••.•a•• • CITY OF CARLSBAD APPUCATION FORM FOR CONSISTENCY DETERMINATION APPLICATION CITY USE ONLY P 15-OffOriginal Project Number:Consistency Determination Number:0)2411m 0001 PROJECT NAME:iCEVS 21vEr2 L (C/ Assessor's Parcel Number(s):?213 -0.6-0 -3R-60 Description of proposal (add attachment if necessary):42/9"/N<-:.44/106K /11447/ezya.staxpo-s 93 /96 -‘.9_.i.>1.--)0V ,6 e-b:_._,ISPI.90 -AIS Would you like to orally present your proposal to your assigned staff planneriengineer?Yes 61 No Please list the staff members you have previously spoken to regarding this project.If none, please so state. OWNER NAME (Print):C-rre E\iS R E42 c.LC APPLICANT NAME (Print):-1271.(ZeEL L .WUL,SP MAILING ADDRESS:x.20.cA5_510.1.2D d:t oz.MAILING ADDRESS:2 ze) a„.415.44 faDizt LsZ CITY, STATE, ZIP:c.412.4.1314 ciej,.::26.t)CITY, STATE, ZIP:reu44245BALD t l c320c1:: TELEPHONE:Xi!)g5S.lgp TELEPHONE:4.1c).20(2 Le.610 EMAIL ADDRESS:04.44F0...64 ULIF m4a -Coi EMAIL ADDRESS:Dp4.464k.luti pjgC:16_fivig 474 *Owner's signature indicates permission to conduct a preliminary review for a development proposal. IN THE PROCESS OF REVIEWING THIS APPLICATION IT MAY BE I CERTIFY THAT 1 AM THE LEGAL REPRESENTATIVE OF THE NECESSARY FOR MEMBERS OF CITY STAFF TO INSPECT AND OWNER AND THAT ALL THE ABOVE INFORMATION IS TRUE ENTER THE PROPERTY THAT IS THE SUBJECT OF THIS AND CORRECT TO THE BEST OF MY KNOWLEDGE. APPLICATION.INVE CONSENT TO ENTRY FOR THIS PURPOSE.I CERTIFY THAT I AM THE LEGAL OWNER AND THAT ALL THE ABOVE INFORMA ION I T E AND CORRECT TO THE BEN OF MY KtfiL G - 5(/‘/yl/ SIG ATUR DATE SIGNATURE DATE APPLICANT'S REPRESENTATIVE (Print):ST -EVE 01-1il4aD MAILING ADDRESS:12.2.2S—wareLN -rts4ne-Oeluk.s'rE.L. CITY, STATE, ZIP:sfqm 1>(64- 1 fly 9a)za) TELEPHONE:Siici EMAIL ADDRESS:4Z)orQ*4#20tousIV.1cre(bA1L.°'•.-Ltj I CERTIFY THAT I AM THE LEGAL REPRESENTATIVE OF THE APPLICANT AND THAT ALL THE ANA)tOFMATIoN IS TRUE AND CORREC THE BEST OF OWLEDGE.M-1 SIGNAT E D FEE REQUIRED/DATE FEE PAID:ir 1- 41 RECEIVED BY:..xt-Gfami P-16 Page 2 of 2 Revised 08/16 INVOICE (00006295) BILLING CONTACT STEVE UTGARD City of Carlsbad City of12225 World Trade Dr San Diego, Ca 92128-3766 1635 Faraday Avenue Carlsbad, CA 92008-7314 Carlsbad INVOICE NUMBER INVOICE DATE INVOICE DUE DATE INVOICE STATUS INVOICE DESCRIPTION 00006295 04/06/2017 04/06/2017 Due NONE REFERENCE NUMBER FEE NAME TOTAL CD2017-0007 CONSISTENCY DETERMINATION (PLN)$733.00 6405 El Camino Real Carlsbad, CA 92009 SUB TOTAL $733.00 TOTAL $733.00 1111111111111111111011111011111111111111111 111 City of Carlsbad Faraday Center Faraday Cashiering 001 1709601 -1 04/06/2017 32 Thu,Apr 06,2017 10:55 AM Receipt Ref Nbr:R1709601 -1/0004 ENERGOV -ENERGOV Tran Ref Nbr:170960101 0004 0004 Trans/Rcpt#:00006295 SET #:00006295 Amount:1 @ $733.00 Item Subtotal:$733.00 Item Total:$733.00 1 ITEM(S)TOTAL:$733.00 Check (Chk#01642)$733.00 Total Received:$733.00 Have a nice day! **************CUSTOMER COPY************* April 06, 2017 10:43 am Page 1 of 1