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HomeMy WebLinkAbout6865APPLICATION I tPERMIT FOR APPLICANT TO FILL IN (Print or type only) YR BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION CITY ZIP NO, OF BLDGS. BUILDING SIZE OF LOT NOW ON LOT ADDRESS TRACT, 4i BLOCK LOT NO. LOCALITY 4v TEL NEAREST OWNER � �` � NO. CROSS ST. ASSESSOR w ADDRESS MAP BOOK PAGE PARCEL DISTRICT GROUP TYPE FIRE PROCESSED BY ' -CITY ZIP t CONST. ZONE ARCHITECT OR TEL l L(of" ENGINEER NO. STATISTICAL CLASSIFICATION SEWER MAP ADDRESS CLASS NO. In Q DWELL. UNITS '� BK PG TEL. CONTRACTOR NO. USE ZONE MAP NO. LIC. 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 HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING SQ. FT p NO. OF NO. OF CHECK FRONT PROP. LINE HIGHWAY WIDTH SIZE (. ,gy' STORIES FAMILIES ONE ,u r + - DESCRIPTION OF WORK NEW ADD BLDG, SETBACK FROM SIDE PROP. LINE OF (STREET) Y I'A���p 1, _° ALTER ❑ / { _ TOTAL SETBACK FROM TYPE OF EXISTING ,i; f l•� ❑ HIGHWAY YARD SIDE PROP. LINE HIGHWAY WIDTH REPAIR USE OF EXISTING BLDG. DEMOL ❑ + _ APPLICANT- TEL `7jIV-�l' , i CORNER CUTOFF YES ® NO ❑ (PRINT) .� r NO. / ii V, IN OPEN SPACE YES NO ❑ BY (SIGNATURE) 4' IN COASTAL PERMIT ZONE YES / NO VALUATION $ I HEREBY ACWLEDGE 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. j SIGNATURE OF �`� �' i i- PERMITTEE ✓V j ADDRESS «, TEL. s' FINAL DATE B CITY NO FEE r J FET. MAKE CHECKS PAYABLE TO: HARVEYT. BRANDT, COUNTY ENGINEER ©a, CK. M.O. CASH !. C %) M 2 0 PERMIT VALIDATION CK. M.O, CASH ®s 76A638A CE #803 3-75