HomeMy WebLinkAboutN/A (1367)APPLICATION 1 1PERMIT
FOR APPLICANT TO FILL IN (Print or type only) p,
BUILDING
DEPARTMENT OF COUNTY ENGINEER
ADDRESS
BUILDING AND SAFETY DIVISION
». CITY ZIP
NO OF BLDGS.
SIZE OF LOT 1 NOW ON LOT
BUILDING
ADDRESS
TRACT
BLOCK
LOT NO.
LOCALITY
TEL. p
OWNER , % /ti! r NO, ;_l� 14, fi
NEAREST
CROSS ST,
ADDRESS (; T - j' r" f -t. " "
ASSESSOR
MAP BOOK
PAGE
PARCEL
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DISTRICT GROUP TYPE FIRE
ZONE
PROCESSED BY
CITY" ZIP �' �� r
CONST.
- ARCHITECT OR . `. - TEL �`; . > e p
(! ENGINEER /�
STATISTICAL CLASSIFICATION
SEWER MAP
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ADDRESS. 7ry .
CLASS NO. DWELL. UNITS
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CONTRACTOR(r a —.✓ %c r'� •" NO.
USE ZONE MAP
LIC.
Z� �f ;t
ADDRESS NO.
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 Pq
+
ADD ❑
BLDG. SETBACK FROM
SIDE PROP. LINE OF
(STREET)
ALTER ❑
TOTAL SETBACK FROM
TYPE OF EXISTING
❑
HIGHWAY + YARD = SIDE PROP. LINE
HIGHWAY WIDTH
REPAIR
USE OF
EXISTING BLDG. DEMOL ❑
+ _
N APPLICANT TEL
CORNER CUTOFF YES ®
NO
(PRINT) NO.
IN OPEN SPACE Y b`
NO ❑
BY )SIGNATURE)
IN COASTAL PERMIT ZONE �
NO
VALUATION $ •. ' %1 r"
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES
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THAT
AND LAWS REGULATING BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE
[[J
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
PERMITTEE
�y
ADDRESS
FINAL BY
TEL.
DATE
CITY NO.
MAKE CHECKS PAYABLE TO:
P.C. PMT.
FEE FEE
HARVEYT. BRANDT, COUNTY ENGINEER
i
I II 4
CK. M.O. CASH
PERMIT VALIVAIIUN CK. M.O. CASH
®S 76A63BA CE #803 3-75