HomeMy WebLinkAbout6857APPLICATION [ 1PERMIT
FOR APPLICANT TO FILL IN (Print or type only)
BUILDING
DEPARTMENT OF COUNTY ENGINEER
ADDRESS
BUILDING AND SAFETY DIVISION
CITY ZIP
NO. OF BUGS.
BUILDING
SIZE OF LOT NOW ON LOT
ADDRESS
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TRACT
BLOCK
LOT
LOCALITY 1(0 l -sa
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.
�. UP, —
ENGINEER NO.STATISTICAL
CLASSIFICATION
SEWER MAP
ADDRESS
i-
CLASS NO. DWELL. UNITS
BK PG
TEL.
CONTRACTOR NO.
USE ZONE MAP
NO.
LIC.
ADDRESS NO.
SPECIAL
CONDITIONS
LIC.
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
I TYPE OF EXISTING
SQ. FT �j NO. OF NO. OF
CHECK
HIGHWAY + YARD = FRONT PROP. LINE
HIGHWAY WIDTH
SIZE z/ �11'? t/ STORIES " FAMILIES
ONE
DESCRIPTION OF WORK
NEW
+
ADD
BLDG. SETBACK FROM
(STREET)
SIDE PROP. LINE OF
1 sy,��ry
�"
ALTER ❑
TOTAL SETBACK FROM
HIGHWAY + YARD =
TYPE OF EXISTING
WIDTH
Vet
❑
SIDE PROP. LINE
HIGHWAY
REPAIR
USE OF
EXISTING BLDG,
DE OL ❑
+ _
APPLICANT JJ TEL /
*
CORNER CUTOFF YES ®
NO
(PR NT) NO
IN OPEN SPACE YES ®
NO
BY (SIGNATURE(' —
IN COASTAL PERMIT ZONE Y
NO ❑
VALUATION
1 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 INSURANCE,
SIGNATURE O
r
PERMITTEE�
ADDRESS
FINAL
BY
TEL.
DATE
CITY NO.
$
MAKE CHECKS PAYABLE TO:
FEE
FEE rya
/�
F ET
HARVEY T. BRANDT, COUNTY ENGINEER
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1-9 WTI l KaG I til Akyrill'111. 91«..
CK. M.O. CASH
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PERMIT VALIVAI WIN CK. M.O. CASH
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