HomeMy WebLinkAboutPIP 95-02; DOMINIE PRESS; Engineering ApplicationCITY OARLSBAD - ENGINEERINGQPARTMENT
APPLICATION
GRADING PERMIT
PROJECT NAME:/)'2A1/,V/6 6.c.s PERMIT NUMBER: Dw G 3+( 94
PROJECT LOCATION: 5'. 5' 0Qcç ,4&'. y cF 'fl','*jc, £44 /'8t
ASSESSOR PARCEL NUMBER(S): Z'Z- — aS V RECEIVED
PROJECT DESCRIPTION:APR_
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OWNER: CITY OF CANLSUAD
ENGINCCRING COUNTER
ADDRESS: 147M_CAMik/,T L41?f3WbA, _&1 _fltM-,C4 910(L
PHONE NUMBER: L -ep-91
I CERTIFY THAT I AM TIj LEGAL OWNER OF THIS OPERTY AND I AUTHORIZE THE GRADING ASSOCIATED
WITH THIS PERMIT. I \ II
OWNER SIGNATURE DATE:
CIVIL ENGINEER: _fl'(dVI'C/F44 _/,.' /4'gr,zy 4,,,1,vsEy
ADDRESS: /" /X fz$z 4(1 /Ø'fJ4J Ca. 9N;ii
PHONE NUMBER:
SOILS ENGINEER:c c77c,dA../
ADDRESS: 09-14 VIA 4E)#cZ:, 474W7o c/44 Z' C'
PHONENUMBER:
GRADING CONTRACTOR:,. _'') STATE LICENSE NO.: cL3'ysj'j'
ADDRESS:s'' _-,4//,rJ.S Yc?/.Z3' CITY BUSINESS LICENSE NO: /70/2/O
PHONE NUMBER:
BASIS OF PERMIT FEES: cv
GRADING QUANTITIES: / 3 c cv cut cyjL
cy remedial V cy4pojjJmport
VERIFIED TOTAL PERMIT FEES: 1 3'O O BALANCE DUE: BY:
I h.v.by .cXnowldg. that I have r.ad the application ud information provided is correct. I agres to coingly with all federal. stat., d city laws, ordinances. regulations
and poas, relating to excavation aid grading including, but not limited to. the Federal Endangered Species Act of 1973 td my un...J.,...,ts thereto, OSHA Pei
rsquclmuttu for trsndit., over flye fee d..p uid the provisions and condition, of any p.mVt issued pu,suutt to this application.
APPLICANT NAMEI41A44L/ PHONE NO 44 _ .ADDRESS: 4 i
APPLICANT'S SIGNAT' _i4.try,DATE:
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P:\D0CS\MISF0RMSFRM00065
0 REV. 12122/93