HomeMy WebLinkAbout6866APPLICATION I IPERMIT
FOR APPLICANT TO FILL IN (Print or type only)
%rVuIV I I yr LWJ MIVUGLra
ADDRESS
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
CITY
ZIP
NO, OF BLDGS.
BUILDING
'r SIZE OF LOT
NOW ON LOT
ADDRESS
TRACT.,,
BLOCK
LOT NO,
LOCALITY®�}C�
OWNER ¢ ��
TEL.
NO.
NEAREST
CROSS ST.
ASSESSOR
ADDRESS
MAP BOOK
PAGE
PARCEL
DISTRICT GROUP TYPE FIRE
PROCESSED BY
-CITY
ZIP
CONST. ZONE
ARCHITECT OR
TEL.
CL"
ENGINEER
NO.
STATISTICAL CLASSIFICATION
SEWER MAP
ADDRESS
CLASS NO. V DWELL. UNITS (
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 + 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
USE OF
EXISTING BLDG.
REPAIR
DEMOL ❑
+
- APPLICANT ' ''jj�
(PRINT) �'f� �j
a TEL y / ',,r'
NO.
CORNER CUTOFF YES ®
NO ❑
IN OPEN SPACE YES ❑
NO ❑
t
BY (SIGNATURE
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
If
AND LAWS REGULATING BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE
WORK AUTHORIZED HEREBY I WILL NOT
EMPLOY ANY PERSON IN VIOLATION OF„,o,
THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM-
;
PENSATIONINSURANCE.
,f'All
SIGNATURE Or r
,
' �I
PERMITTEE
ADDRESS
" % ri
FINAL BY
TEL. `
DATE
CITY
NO.
MAKE CHECKS PAYABLE TO:
P.C.EFEET
HARVEY T. BRANDT, COUNTY ENGINEER
L
Z"
:o
®s 76A63BA CE #803 3.75'
CK. M.O. CASH
, SM C
0 �:-
PERMIT VALIDATION CK. M.O. CASH