HomeMy WebLinkAbout160 HEMLOCK AVE; ; 63-5402; PermitAPPLICATION FOR Buf?n 116 PERMIT
5402
CITY OF CARLSBAD -BUILDING INSPECTION DIVISION
PHONE PArlcway 9-1181 • Erl. 36
?Pi:::. ~~~;)-:::..G~~~,et·· ~;~~4/..£ (Middle)
Contractor .. ~·-··-~ ~ • (Please Print)
M,iling Address/ .. t.<: ~ .. ~
Number Street City Phone
ailing Addreu / ~ ~ 'fe /4 ""·Q ~ ~ Ill (6 /e /"/ ec~////4
Number 7s;:;eet City Phone
To Construct 9( To Add D To Alter O To Repair O To Convert O To Move From ········---------,---
Type of Const . .;ib~,:'f~.".~11.undation. ~ ... ~ ..... No, of Stories .,Z, .. To Be Used for /f..d,_~re.½~;;t;; @)
{Frome, Masonry, Etc.} (Ono Family. wellinq, Store, Etc.)
Floor Space of Proposed Construction {sq. feet) .!J.., .. £1...~ ...... Const. Valuation $ ..... a..£., ... ,1}.. O ~ ... µ ... µ,,,;;. f·"
:~~~:P:::;:l:;l::e .{~::.~e.et) ·-;;~/ £71.1.. ::i~~ 1&onst .. ~~l~~e?~:""::": ,_ ______ _
Cot Block Subdivision
LAND AREA ...................................... NUMBER OF EXISTING DWELLINGS ON PROPOSED BUILDING SITE ________ {INDICATE
SIZE, USE AND LOCATION ON PLOT PLAN). WILL THIS CONSTRUCTION INCLUDE ANY PLUMBING INSTALLATION, ALTERATION, OR
ADDITION? YES .... 1'····• NO ................•
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUCTION,
If a check is tendered for i;tiyment of the above fee end the check is
not honored when presented for payment, your Building Permit will be
immediately revoked.
SIGNATURE OF
PERMITTEE ..
Front Yard Set Back ...... cP..:Q .. ~•···~---
-; ~
Side Yard Set Back ·········~·············--------
Rear Yard Set Back .... L'2. .... ~ ......... __ t..----__ _
Distance Between Bldg. /0.. .. ,
Off Street Park!ng Spaces ... ~~··~
Sewage Disposal System ·········~
Zone. Residential ( .. ~) ------------
Zone • Commercial
Variance
Eng. Check By ·······~~-I-'----
Driveway Permit Required Yes (.v) No ( ) Fee ...... ..fl, /#2§ -
1
-
(/lffd a or,: or E ~ :,:,.e,,,,;_,)
~rading Permit Requi~ed Yes ( ) No ("-1 ~/
Sewer Disposal Plant Capital Cont. Fee µ~-1(!.T.:J .. ,,_) ___ ~'4.'~0• o o
• ✓
Sewer Pumping Station Capital Cont. Fee -~----·--------
Sewer Main Une Cost ............ 4. Q $..:_/9._;;i_9.._'--·------
/.?ou, 1/"5 v,. p,,; ?."""
Sewer Lateral Connection Charge _________ $.~y <.~ 50
Water Stocked Lands Charge _________________ _ -Water Main Pipe Line Fee ....
Water House Service Charge . ./ .. ✓-~-3--P.'/£/~ t) C,
Water Meter Charge .......... / ... ~~······· ' ............... 7 ~-----
Sub Total ----¾-1.Z..•~----------
Plans Approve~···············-/(-)·-c---·-----Plan Check Fee ................ .
Approved by ..... ~.~·····~ ,"(....,-c ~·········Building Permit Fee .,!!'J.8...o. ..... ~.~·······-z;----~/~-} .......... .
Date ........... 8..~ ... P.!:. .. 6..=···6.-.~ Total Charges .. ~ .. J .... J.-..-":•==--------
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