HomeMy WebLinkAboutCD 2017-0017; MOSS RESIDENCE; Consistency Determination (CD)0 0
CITY OF CARLSBAD APPLICATION FORM FOR CONSISTENCY DETERMINATION APPLICATION
CITY USE ONLY
Original Project Number: CDP O'? o'{ (.p Consistency Determination Number: CV 2.,o \ 1 -00 l 1
PROJECT NAME: 5015 Tl £.f=!gA DEL oe.o -MOS=> 12.ES>t DEJvGC
Assessor's Parcel Number(s): 2.lo-020 -15
Description of proposal (add attachment if necessary): PLA\.J cow ~\ & c..-( o F APF120llEP
APPf7ovw c.rrt CJF CAlZLSBAP
Would you like to orally present your proposal to your assigned staff planner/engineer? Yes D
D
No
Please list the staff members you have previously spoken to regarding this project. If none, please so state .
.JACbON GoF"P
OWNER NAME (Print): M/M ~Te:\/E MO'::,$
MAILING ADDREss: 215 4oe cOL.e:~ WA'I
CITY, STATE, ZIP: CA MbA-S. c.A q 1.302.
TELEPHONE: I _qqtp-2000
EMAILADDREss: ve @. PAC,F')C.\/l~w, a,-c
•owner's signature indicates pennission 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. I/WE CONSENT TO ENTRY FOR THIS PURPOSE. I
CERTIFY THAT I AM TH LEGAL OWNER AND THAT ALL THE ABOVE
INFORMATION IS TRU ND CORRECT TO THE BEST OF MY
KNOWLEDGE.
SIGNATURE
CITY, STATE, ZIP: ~i.Jf'JTAltJ ~El.J"TE:£.
TELEPHONE: 8 l 8 -roo I -5 (pO 1
EMAIL ADDRESS: l.AVOS"f,IC:,N €. E'A~THLIIJI.{.
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.
APPLICANT'S REPRESENTATIVE (Print): -i.AvATTO ve:~l loN G, eov p
MAILINGADDRESS: f.t:J04oo DE:VILS L--ADDE:f2. 12.oAD
CITY, STATE, ZIP: MOUN:[Alt.J C.~NTl:::IZ-, CA q 2-5(.e, /
TELEPHONE: B \ B-&-;01-S(pO I 1
EMAIL ADDRESS: l-AVDESl6N cs ~AJZ.THl...t lvk:, 1'.JGT
I AM THE LEGAL REPRESENTATIVE OF THE APPLICANT AND THAT ALL THE ABOVE INFORMATION IS TRUE AND
'1-.1.a.+-B_E_STOFMYKNCNVLEDGE~-, RECEIVED
FEE REQUIRED/DATE FEE PAID:
RECEIVED BY:
P-16
i 1-:i;'?; I &-21-1,
Page 2 of 2
CITY OF CARLSBAD
PLANNING DIVISION
Revised 03/17