HomeMy WebLinkAboutCD 2021-0015; THE FORUM; Consistency Determination (CD)CITY OF CARLSBAD APPLICATION FORM FOR CONSISTENCY DETERMINATION APPLICATION
PROJECT NAME: f=oru)'.111 11'2.~ -1~4' 5½ reW10 e I
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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 W No
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Please list the staff members you have previously spoken to regarding this project. If none, please so state.
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OWNER NAME (Print):
MAILING ADDRESS:
CITY, STATE, ZIP:
TELEPHONE:
EMAIL ADDRESS:
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*Owner's signature Indicates permission to conduct a preliminary
review for a development proposal,
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
APPLICATION. I/WE: CONSENT TO ENTRY FOR THIS PURPOSE. I
CBRTIFY THAT I AM THE LEGAL OWNER AND THAT ALL THE ABOVE
INFORMA TIO S TRUE ND CORRECT TO THE BEST OF MY
LEDGE.
MAILING ADDRESS:
CITY, STATE, ZIP:
TELEPHONE:
EMAIL ADDRESS:
APPLICANT NAME (Print): t>¾v\
MAILING ADDRESS: 9c.y:3q 'ttr?t:~ <Sl Sk 2,o-i.
CITY, STATE, ZIP: • CA 1 <-121 ~1
TELEPHONE:
EMAIL ADDRESS:
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
MAY 2 5 2021
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I CERTIFY THAT I AM THE LEGAL REPRESENTATIVE OF THE APPLICANT AND THAT ALL THE ABOVE INFORMATION IS TRUE AND
-GORRECT TO THE BEST OF MY KNOWL£DGE.------------
SIGNATURE DATE
FEE REQUIRED/DATE FEE PAID:
RECEIVED BY:
P-16 Page 2 of 2 Revised 02/28/18