HomeMy WebLinkAboutCD 2021-0001; GREEN DRAGON COLONIAL VILLAGE; Consistency Determination (CD)CITY OF CARLSBAD APPLICATION FORM FOR CONSISTENCY DETERMINATION APPLICATION
PROJECT NAME: GREEN DRAGON TA VERN & MUSEUM
Assessor's Parcel Number(s) and 211-050-04, 211 -050-16 & 211 -040-21
Address: 6115 PASEO DEL NORTE, CARLSBAD, CA 92011
Description of proposal (add attachment if necessary):
EXISTING TEMPORARY OUTDOOR PATIO STRUCTURE PERMIT TO PERMANENT OUTDOOR PATIO
STRUCTURE PERMIT.
Would you like to orally present your proposal to your assigned staff planner/engineer? Yes 0
D
Please list the staff members you have previously spoken to regarding this project. If none, please so state.
KERRY JEZISEK & CHRISTINA RODRIGUEZ
OWNER NAME (Print): BRUCE R. BARTLETT APPLICANT NAME (Print): BRUCE R. BARTLETT
No X
MAILING ADDRESS: 61 15 PASEO DEL NORTE MAILING ADDRESS: 61 15 PASEO DEL NORTE
CITY, STATE, ZIP: CARLSBAD, CA 92011
TELEPHONE: (760) 918.2455 -------------------EM A IL ADDRESS: :3o\..n , L.e.-¥-@e,:e.enin>@t1hlCQ(a
*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. IM/E CONSENT TO ENTRY FOR THIS PURPOSE. I
CERTIFY THAT I AM THE LEGAL OWNER AND THAT ALL THE ABOVE
INFORMATION IS TRUE AND CORRECT TO THE BEST OF MY
KNOWLEDGE. ~,r, ~ rinuc.e Ir~ rJ:1151,1-0
SIGNATURE DATE
APPLICANT'S REPRESENTATIVE (Print): JOHN LEK
MAILING ADDRESS: 6115 PASEO DEL NORTE
CITY, STATE, ZIP: CARLSBAD, CA 92011
TELEPHONE: (760) 797.5579
CITY, STATE, ZIP: CARLSBAD, CA 92011
TELEPHONE: (760) 918.2455
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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SIGNATURE DATE
EMAIL ADDRESS: John. Lek@greendragontavernca.com
I CERTIFY THAT I AM THE LEGAL REPRESENTATIVE OF THE APPLICANT AND THAT ALL THE ABOVE INFORMATION IS TRUE AND
CORR cCT _JO THE BEST OF MY KNOWLEDGE. . .
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SI ATURE DATE JAN 1 4 2021
EE REQUIRED/DATE FEE PAID: $774
RECEIVED BY: ~-h':-J--r...._-,)-O(J_le._i(_~-------------
P-16 Page 2 of 2 Revised 02/28/18