HomeMy WebLinkAboutCD 2017-0007; HULSE ORTHODONTICS MEDICAL OFFICE; Administrative Permits (ADMIN).a•••v •••-••••.•a••
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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
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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!
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April 06, 2017 10:43 am Page 1 of 1