HomeMy WebLinkAbout6850FOR
CATION
NG
FOR APPLICANT TO FILL INS (Print or type only) j [ , AP PERMIT
e
" BUILDING
DEPARTMENT OF COUNTY ENGINEER
ADDRESS
f
BUILDING AND SAFETY DIVISION
CITY.. � ZIP
y� y NO. OF BLDGS. w
BUILDING
SIZE OF LOT 18y 1 NOW ON LOT
ADDRESS
TRACT'1 �
BLOCK"
LOT NO. -
LOCALITY (j
8�
OWNER OE{C l �f NO.Oay
NEAREST
CROSS ST.
ADDRESS!23 c" - } d�!
ASSESSOR
MAP BOOK
PAGE
PARCEL
CWd
DISTRICT GROUP TYPE FIRE
CONST. ZONE
PROCESSED BY
-CITY %�� - ZIP
m4ow
ARCH ECT OR TEL.
A
`
ENGINEER NO.
STATISTICAL CLASSIFICATION
SEWER MAP
ADDRESS `.
CLASS NO. 0 DWELL. UNITS
BK PG
yy-
" CONTRACTORS e�4 l f` + NO. b
USE ZONE MAP
LIC.
NO.
NO.
SPECIAL
L ADDRESS ��
'
CONDITIONS
_
LIC.
CITY �CLASS_
ROAD DEPARTMENT APPROVAL REQUIRED
YES ❑ NO ❑
CONSTRUC I ENDER �y � 1, � '
BLDG. SETBACK FROM
NAME AND BRANCH
(STREET)
q
CITY
FRONT PROP. LINE OF
ADDRESS j
TOTAL SETBACK FROM
HIGHWAY +YARD =
TYPE OF EXISTING
SO. FT. "C NO. OF NO. OF CHECK
FRONT PROP. LINE
HIGHWAY WIDTH
SIZE -STORIES FAMILIES ONE
DESCRIP o RK S5-; ' = NEW
����
+ _
a
p, -t �, w ADD
e "t
BLDG. SETBACK FROM
SIDE PROP, LINE OF
SIDE
(STREET)
_ ep ALTER El
A i IZ_
❑
SETBACK FROM
HIGHWAY + YARD = SIDE PROP. LINE
TYPE OF EXISTING
HIGHWAY WIDTH
REPAIR
" USE OF
EXISTING BLDG. DEMOL ❑
+ _
APPLICANT TELAd "I..
r
CORNER CUTOFF YES ®
NO
(PRINT( ,ec NO.
'-
IN OPEN SPACE YES ®
NO
BY (SIGNATURE(dL1:, ,'
IN COASTAL PERMIT ZONE YES ®
NO
w VALUATIONM1
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. 1 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 OF
q
PERMITTEE
��WIN p,Al /v-
ADDRESS
1 —
` .
FINAL
BY
�( TEL.
44
DATE
CITY l- NO.
MAKE CHECKS PAYABLE TO:
FEE $
FEET
HARVEYT. BRANDT, COUNTY ENGINEER
i�11�
CK. M.O. CASH
PERMIT VALI®ATIUN CK. M.O. CASH
®5 76A63BA CE tt803 3-75'
