HomeMy WebLinkAbout6858APPLICATION I 1PERMIT
FOR APPLICANT TO FILL IN (Print or type only)
BUILDING
DEPARTMENT OF COUNTY ENGINEER
ADDRESS
BUILDING AND SAFETY DIVISION
CITY
ZIP
NO. OF BLDGS.
BUILDING
SIZE OF LOT
NOW ON LOT
ADDRESS
TRACT
BLOCK
LOT NO.
LOCALITY CL
TEL.
NEAREST
OWNER
NO.
CROSS ST.
ASSESSOR
ADDRESS
MAP BOOK
PAGE
PARCEL
DISTRICT GROUP TYPE FIRE
PROCESSED BY
-CITY
ZIP
..ram CONST. ZONE
t 0 j
I
�(� q (�
ARCHITECT OR
TEL.
1 Yv \�- '_
ENGINEER
NO.
STATISTICAL CLASSIFICATION
SEWER MAP
ADDRESS
CLASS NO. 0 0 DWELL. UNITSA-AJ
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
HIGHWAY F YARD =
TYPE OF EXISTING
SQ. FT. NO. OF
NO. OF CHECK
FRONT PROP, LINE
HIGHWAY WIDTH
SIZE STORIES
FAMILIES ONE
DESCRIPTION OF WORK
NEW
+
ADD
BLDG. SETBACK FROM
SIDE PROP. LINE OF
(STREET)
ALTER ❑
TOTAL SETBACK FROM
TYPE OF EXISTING
®
HIGHWAY + YARD = SIDE PROP. LINE
HIGHWAY WIDTH
EXISTING BLDG.
REPAIR
DEMOL ❑
+
APPLICANT �' �:
�r
TEL A!=
CORNER CUTOFF YES ®
NO ❑
(PRINT)
NO.
NO ❑
_WV
uIN
OPEN SPACE YES ❑
BY (SIGNATURE) e' -
IN COASTAL PERMIT ZONE YES ®
NO
VALUATION,
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES
t1
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-
PENSATIONINSURAN
IYILI
t
SIGNATURE OF �6
PERMITTEE
Fl
ADDRESS
F'
FINAL BY
DATE
- CITY
O•
FEE' $ F ET G
P
MAKE CHECKS PAYABLE TO:
HARVEYT. BRANDT, COUNTY ENGINEER_j
���
S
CK. M.O. CASH
rj 0 8 0
PERMIT VALIDATION CK. M.O. CASH
®s 76A638A CE #803 3-75'