HomeMy WebLinkAbout7875• • • 1
APPLICATION
DEPARTMENT OF COUNTY ENGINEER1
BUILDINGD' AND •
FOR APPLICANT TO FILL INa
BUILDING
ADDRESS��--
y�
BUILDING ADDRESS r,f•,/ %II� � t � � t�1
LOCALITY
CITYZIP
NEAREST
CROSSST.,�
NO. OF BLDGS.
SIZE OF LOT NOW ON LOT
ASSESSOR 'r
MAP BOOK �t
PAGE
PARCEL
/� LOT NO. �
"�//C%Ci 1q! 72 BLOCK �
DISTRICT GROUP TYPE
CONST
FIRE
h:
PROyPESSED BY
/
TRACT
G,_ ,
�,�
��gg
OWNER ( N L� M"% JTv Jl'gfl NO.
STATISTICAL CLASSIFICATION
MAP
ADDRESS
CLASS NO. `' / DWELL.
UNITS
tSEWER
BK �_"�PG
CITY ZIP
USE ZONE MA
NOP ` a��-• .�
�.1
ARCHITECT
�ff
SPECIAL
I A14,0 NOJ_I
ONSENGINEER
CONDITI
ADDRESS .. 64 mat I,( elf i
ROAD DEPARTMENT APPROVAL REQUIRED
YES ❑ NO
TEL
CONTRACTOR NO.
BLDG. SETBACK FROM
FRONT PROP. LINE OF
(STREET)
LIC.
ADDRESS NO.
HIGHWAY t YARD = TOTAL SETBACK FROM
FRONT PROP. LINE
TYPE OF EXISTING
IHIGHWAY WIDTH
LIC
CITY CLASS
_
CONSTRUCTION LENDER
NAME AND BRANCH
BLDG. SETBACK FROM
SIDE PROP. LINE OF
r
(STREET)
ADDRESS CITY
j
OTAL 3 BACK FROM
TYPE OF EXISTING
SQ. FT. NO. OF NO. OF CHECK
HIGHWAY + YARD
A
SIDEPROP. LINE
HIGHWAY WIDTH
SIZE STORIES FAMILIES ONE
DESCRIPTION OF WORK NEW
❑
NO ❑
4 g-� 1Wt ADD ❑
F�
CORt`1ER CUTOFF
YES
ALTER ❑
IN OPEN SPACE
YES ❑
NO ❑
REPAIR ❑
USE ❑
IN COASTAL PERMIT ZONE
YES ❑
NO ❑
EXISTING BLDG. '� DEMOL
APPLICANT TEL
(PRINT) NO.
BY (SIGNATURE)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES
AND LAWS REGULATING BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE
WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF
THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM-
INSURANCE.
PENSATION t! )
�1
J
FINAL
BY
SIGNATURE OFI (� a
� "w
PERMITTEE
DATE
ADDRESS
TEL.
P.C. Fee $ /K I -Ad
Permit Fee
CITY NO.
t
Issuance Fee
3 ( �
VALUATION $-
/
Total Fee
CK. M.O. CASH
iCKMII YMLIYWIIVIV CK. M.O. c�a5n
!PDS 76A638A CE #803A 6/76