HomeMy WebLinkAboutCD 2018-0004; LA COSTA GREENS GYM EXPANSION; Consistency Determination (CD)CITY OF CARLSBAD APPLICATION FORM FOR CONSISTENCY DETERMINATION APPLICATION
CITY USE ONLY Development Number: "!l1,..D11
Original Project Number: ~ul) Ot.,-11\ >, Consistency Determination Number: C Q 2.& l ~ -o o o
PROJECT NAME:
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 D (Q
D
Please list the staff members you have previously spoken to regarding this project. If none, please so state.
OWNER NAME (Print):
MAILING ADDRESS:
CITY, STATE, ZIP:
TELEPHONE:
EMAIL ADDRESS:
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
APP TION. IMIE CONSENT TO ENTRY FOR THIS PURPOSE. I
C TIF THAT I AM THE LEGAL OWNER AND THAT ALL THE ABOVE
I OR TION IS TRUE AND CORRECT TO THE BEST OF MY
0 LED E. ~ \· Ii
DATE
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
APPLICANTS REPRESENTATIVE (Print): -1,,A.i.' [1,,,J2£;,c:~tzr1=1-M~olecii;...:b..i..:1.::,\l~e.;;.... _____________ _
MAILING ADDRESS t "'5"5L. :f?e::e>'Tt'J 4Zp@
CITY.STATE.ZIP i;;..~Pt:PoJ a i:r?ow
TELEPHONE: 11 <:!!_ _,,. r:!-/1 ,,. _a._ ,I C--z • ~-~='"!-
EMAIL ADDRESS ~Qk:> 1 9¾ t?ct0 ~ .c-cc1
·.1 ,·.,r LEGAL REPRESENTATIVE OF THE APPLICANT AND THAT ALL THE ABOVE INFORMATION IS TRUE AND
OF MY KNOWLEDGE. g..1-.,~
DATE
FEE REQUIRED/DATE FEE PAID:
RECEIVED BY: -. I ··, ·•'\r)d \ ·" ... \ 1t .,1 i. I,
810Z O i ~d-q
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