HomeMy WebLinkAbout6854APPLICATION 1 1PERMIT FOR APPLICANT TO FILL IN (Print or type only) ..amid � � <.r e.aia ranevse�a .T BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION i CITY ZIP NO. OF BLDGS. BUILDING SIZE OF LOT NOW ON LOT ADDRESS t TRACT BLOCK LOT NO. LOCALITY TEL. NEAREST OWNER NO, CROSS ST. ASSESSOR ' ADDRESS MAP BOOK PAGE PARCEL DISTRICT GROUP TYPE FIRE PROCESSED BY -CITY ZIP CONST. ZONE ARCHITECT OR TEL. ' l c/` ' ENGINEER NO. STATISTICAL CLASSIFICATION SEWER MAP ADDRESS CLASS NO. 0 DWELL. UNITS BK PG TEL. CONTRACTOR NO. USE ZONE MAP LIC. NO. ADDRESS NO. SPECIAL LIC. CONDITIONS ' CITY CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑ CONSTRUCTION LENDER NAME AND BRANCH BLDG. SETBACK FROM FRONT PROP. LINE OF (STREET) ADDRESS CITY TOTAL SETBACK FROM TYPE OF EXISTING SQ. FT NO. OF NO. OF CHECK HIGHWAY + YARD = FRONT PROP. LINE HIGHWAY WIDTH SIZE f r° STORIES FAMILIES ONE DESCRIPTION OF WORK NEyV + ADD ❑ BLDG. SETBACK FROM SIDE PROP. LINE OF (STREET) "f ALTER ❑ TOTAL SETBACK FROM TYPEOF EXISTING HIGHWAY + YARD = PROP. HIGHWAY REPAIR ❑ SE F ' EXISTING BLDG. DEMOL El APPLICANL TEL r p " „ 5 NO. l ®'��� CORNER CUTOFF YES ® NO ❑ IPRINTJ t IN OPEN SPACE YES ❑ NO ❑ BY (SIGNATURE " IN COASTAL PERMIT ZONE YES NO _ VALUATION ?i /. L,., (c i 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- PENSATION INSURA. SIGNATURE OF ���CCC PERM ITTEE ADDRESS FINAL BY TEL. DATE CITY NO. MAKE CHECKS PAYABLE TO: FEE F ET HARVEYT. BRANDT, COUNTY ENGINEER �/ c �1, PGA CK. M.O. CASH �)L10.90 PERMIT VALIDATION CK. M.O. CASH ©S 76A638A CE #803 3-75'