HomeMy WebLinkAboutPIP 95-03; EXHIBIT ART LOT 43; Engineering ApplicationPj 5Q3
CITY O•ARLSBAD -'ENGINEERING fEPARTMENT
APPLICATION
GRADING PERMIT
PROJECT NAME: fX111,017 ,197- , PERMIT NUMBER: 6ie-
PROJECT LOCATION:—,4/,:F 1111V-1f lrae
ASSESSOR PARCEL NUMBER(S): 2/2 -7%
PROJECT DESCRIPTION: .57-eF _ c
tL. r-
OWNER: 4l4CA4s./
ADDRESS:
PHONE NUMBER:
/
I CERTIFY THAT I AM THE LEGAL OWNER OF THIS PROPERTY AND I AUTHORIZE THE GRADING ASSOCIATED
WITH THIS PERMIT.
OWNER SIGNATURE DATE:
CIVIL ENGINEER:'.
ADDRESS: '2sez '4
PHONE NUMBER: ('V 4f- 57°3
SOILS ENGINEER:
ADDRESS:1/4. qzzj
PHONE NUMBER: i'9
GRADING CONTRACTOR: hl 57 'STATE LICENSE NO.:________
ADDRESS: '" '? CITY BUSINESS LICENSE NO:____________
PHONE NUMBER: Z79 — 51Z -1
BASIS OF PERMIT FEES: 2 / 6'O Cy '
GRADING QUANTITIES:' Z I 60 Cy cut Cy fill
cyremedial cye Qojt
VERIFIED
TOTAL PERMIT FEES: BALANCE DUE: " BY:
I h.r.by .cknowl.dg. that I have read the appkation and information provided is correct. i agree to coiy with all federal. stat., WW city laws, ordinances. regulations
and policies relating to excavation and grading induding. but not IirrVtsd to. the F.dsnd Endangered Spies. Act of 1973 and any .nand..,.nt, thereto. OSHA Permit
r.quit.msnts for trandit.s over five fist ds.p and the provisions and conditions of any permit issued pursuant to this application.
APPLICANT NAME, 1I.-7dc' PHONE A D D R ES5:9
11
APPLICANT'S SIGNATU'd4 4' DATE:
P:\D0CS\MISF0RMSFRM00065 7 REV. 12122193
/
S S a
CITY OF CARLSBAD. ENGINEERING DEPARTMENT
APPUCAT1ON
FOR ENGINEERING PLANCHECK OR PROCESSING
Cont0oft aN Wpropdats Ironnedon. Ofte N/A who not sppAlc.tJs.
PROJECT NAME:&XH"I7T &T DATE:___________
PROJECT DESCRIPTION:
- Lr- i? UCCJG - .1iJc:1J4
PROJECT ADDRESS: 1j. (qn,jerz_Kaf1ccj 4)e-. (t 1U€
LOT NO(S).:__________ MAP NO.:14288 APN(S).:
OWNER: c(. A (}1AkeMJ APPLICANT: 1
Ik)cl K4t (4 4 (C Si. J
Mailing Address: 1313 S, p Mailing Address:
4M
Phone Number. - Ph am Nufliber I
I certify that lam the legal owner and that all the above lrdonnon I certify that I am the agent of the legal owner and that all Wonnon on
Is true and correct to the beat of my knowledge. this shed Is true and correct to the beat of my knowl.dgs.
Signature Date_______ I Signature Date__________
CIVIL ENGINEER:OLt —bi. '(M <&(
Firm: tJ'tti P4-I ce'-6
Mailing Address:
SOILS ENGINEER:_________________________
Firm:
Mailing Addrser
Phone Number M 3 -A0,3 ,6> Phone Number I
State Registration Number Stats R.gl*ation Number
LANDSCAPE ARCHITECT:I ADDITIONAL COMMENTS:__________________
Firm:
Mailing Address:
Phone Number I
State R.gi*atlon Number-
NO. OF P EWNG.lJNflS:__ LFMP ZONE: NO. OF LOTS: / NO. OF ACRES: /6
IMPROVEMENT VAUAflON
__
ser, water & reclauned water______________
streets and drainage: landscape: _'water district____________
GRADING OUNTmES:- CY cut ?-IRt cy 'flI ' ci
remedial
t/) 'EASE HECK OFF APPLICATION TYPES ON REVERSE SIDE
P:\D0C3\MISF0RMSWRM000SI REV I2116/93
* . REVMGM
I
FOR CITY USE ONLY
APPLICATION FOR 'r f Dep Fees (CHECK ALL-THAT APPLY): 17? °
O Boundary Adjustment
O Adjustmeit Plat , ,.
O Certificate of Compliance
O Dedication of Easement - 'r -.
Type;. .
Encroachment Permit . .
0 Ergineeririg Standards Va1ace
OFinal Map