HomeMy WebLinkAboutPIP 95-01; AMERICAN RIM SUPPLY; Engineering ApplicationCITY 0 ARLSBAD - ENGINEERING IPARTMENT
APPLICATION
GRADING PERMIT
PROJECT NAME: A/ 1Z14'l J?Añ2_(-1 PERMIT NUMBER:
PROJECT LOCATION: . k-T
ASSESSOR PARCEL NUMBER(S): 2 1 '2- -O%' --0?
PROJECT DESCRIPTION: rNriocTrt'&
OWNER: &Cl/ M4 ,z-P.
ADDRESS: Z-/ J f,4,v74 . 4) A14,€Co'S
PHONE NUMBER:
.
I CERTIFY THAT I AM THE LE A9OWNER OF THIS PROPERTY AND I AUTHORIZE THE GRADING ASSOCIATED
WITH THIS PERMIT. / 4 .
OWNER SIGNATURE. / 0
DATE:
CIVIL ENGINEER: .juU\k
ADDRESS: 2 ,
PHONE NUMBER: NUMBER: . .
SOILS ENGINEER: C1 E
ADDRESS: 'Lt4JL/ VA,W14 Aj STE 1.AL.. ())
PHONE NUMBER: -jrq
GRADING CONTRACTOR: /Vfli -OWO STATE LICENSE NO.: C cci
ADDRESS:37_tc.k.4.._D.5112 CITY BUSINESS LICENSE NO: I &'aic,' PHONE NUMBER: 41r, _9_-2i _:s
BASIS OF PERMIT FEES: 401w cy
GRADING QUANTITIES: 4,1160 cv cut _6--1 cy fill
cy remedial 9-07 cy export/import
VERIFIED TOTAL PERMIT FEES: 0 BALANCE DUE:,- BY:
I hereby acknavviedge, that I hiv• read the EØC.ticø and ifvn.cn Provided is co,v.ct. I agres to ccivy with d federal. state. &W city laiwe. ordinances. regulations d policies relating to excavation end grading including, but not IWvtit.d to. the Federal Endangered Sp.ciN Act of 1973 arid wy im.win.it. thereto, OSHA Psrnit requirements for t,widtsu over five feat do" arid the provisions and conditions of eny p.mt iswa.dpwsuwil to this appiliestim.
APPLICANT NAME ,2,stJt\ft-._. PHONE NO. —12 ,ADDRESS: 47.S t,O. aAre (&J-. e
APLICANT'S SIGNATURE:
. DATE: 14
P:DOCS\MISFORMS\FRM60065 0
0 7 . REV. 12122/93
CITY OSARLSBAD - ENGINEERING øPARTM ENT /ó'Q7,7
APPLICATION
GRADING PERMIT
PROJECT NAME:P'4/C.4"J /e,o6 SA4/fl PERMIT NUMBER:_______________ 1
PROJECT LOCATION: S .571,0,6 /Jeç-ç Aue &y /4OI 4'E.
ASSESSOR PARCEL NUMBER(S): ___—ey Z _09
PROJECT DESCRIPTION:Y'7f
7747 -4V
OWNER: i7fk
ADDRESS: I ,5 -A m
PHONE NUMBER: (6 157 — 1777
I CERTIFY THAT I AM THE LEGAYaNER OF THIS PROPERTY AND I AUTHORIZE THE GRADING ASSOCIATED
WITH THIS PERMIT. C
OWNER SIGNATURE 1 DATE:
CIVIL ENGINEER: /#d,iT '_SLf7//',4&:/f/,/-%;.
ADDRESS: 4 3'2
PHONE NUMBER:
SOILS ENGINEER: _ 4i.
ADDRESS: Z/4.L,iA/ _7AfrWt/
PHONE NUMBER: 7449
GRADING CONTRACTOR: • STATE LICENSE NO.:_________
ADDRESS: CITY BUSINESS LICENSE NO:______________
-PHONE NUMBER:
BASIS OF PERMIT FEES: cy
GRADING QUANTITIES: cy cut cy fill
cy remedial cy export/import
VERIFIED TOTAL PERMIT FEES: • BALANCE DUE: BY:
I hereby scowt.ds that I have read the application ssd information provided is ca!vsct. I agree to comply with all federal. stat.. and city laws, ordinances. regulations '
d Policies relating to sxc.v.tion and grading including, but not Iintit.d to. the Federal Endangered Species Act of 1973 and .y aTlsndm.t. th.r,jto, 0%4 Psrnit
requirements for trenches over lve feet deep .d the provisions and conditians of ey • is,uad puran to this uIc.bcn. 6/
APPLICANT NAME _______nIT. PHONE .,ADDRESS: 1' 2.f
APPLICANT'S SIGNATURE: DATE: DATE:
P:\D0CS\MISF0RMS\FRM00086 7 REV. 12122/93