HomeMy WebLinkAbout6848I - APPLICATION FOR BUILDING PERMIT
FOR APPLICANT TO FILL IN (Print or type only)
R.UvW_
mlllmllmmmm
. — —
BUILDING
ILDING
DEPARTMENT OF COUNTY ENGINEER
ADDRESS
BUILDING AND SAFETY DIVISION
CITY ZIP
6,J
NO. OF BLDGS.
SIZE OF LOT&C`j�f NOW ON LOT d
BUILDING
ADDRESS
TRACT�p=)
BLOCK
LOT NO.
LOCALITY
TE1
OWNER NO,LNi
NEAREST
CROSS ST.
-Ij
C11V
ASSESSOR
ADDRESS [J,'f �A i kka
MAP BOOK
PAGE
PARCEL
With, �& j
DISTRICT GROUP TYPE FIRE
CONST. ZONE
PROCESSED BY
-CITYAA�A CA ZIP I
—
ARCHITECT O
NO.
ENGINEER
STATISTICAL CLASSIFICATION
SEWER MAP
ADDRESS a��L4
CLASS NO. DWELL, UNITS
BK PG
EL fi,
7 No *.
CONTRACTOR 1
-0-()—
USE ZONE MAP
LIC.
ADDRESS A- NO.
NO.
SPECIAL
LIC.
CONDITIONS
CITY CLASS
ROAD DEPARTMENT APPROVAL REQUIRED
YES ❑ NO ❑
CONSTRUCTION LENDER ' 11
NAME AND BRANCH
BLDG. SETBACK FROM
(STREETI
IM, CITY 1 jA
FRONT PROP. LINE OF
ADDRESS
'CHECK
HIGHWAY + YARD TOTAL SETBACK FROM
TYPE OF EXISTING
SQ. FT NO. OF j NO. F
FRONT PROP. LINE
HIGHWAY WIDTH
SIZE STORIES ONE
DESC'Rll 1l8 i 3F WORK
+
ADD Ej
BLDG. SETBACK FROM
SIDE PROP, LINE OF
ISTREET)
ALTER ❑
TOTAL SETBACK FROM
+ YARD
TYPE OF EXISTING
HIGHWAY SIDE PROP. LINE _
HIGHWAY WIDTH
REPAIR
USE OF
EXISTING BLDG. DEMOL
+
vy
APPLICANT IW/qe C ffV C TEL. jj
NO
CORNER CUTOFF YES
NO F]
(PRINT)
IN OPEN SPACE YES ❑
NO ❑
BY (SIGNATURE)
IN COASTAL PERMIT ZONE YES
N
VALUATION $r cr, A
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 INSURANCE.
SIGNATURE OF
LAI'
PERMITTEE
6-1 v
ADDRESS 0
ti
4
FINAL
BY
TEL-.-Q
CITY &Awm. CA —NO7i4'
If)
DATE
MAKE CHECKS PAYABLE TO:
FEE ' $
S
M$
FEET
HAIR EY T. BRANDT, COUNTY ENGINEER
gG
UJFTTTF1491_TUV��
CK. M.O. CASH
2 2 0 10) 0
PERMIT VALILIAI IUN CK. M.O. CASH
(E)s 76A638A CE #803 3-75