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HomeMy WebLinkAbout3255ANMI R FOR APPLICANT TO FILL IN ADDRRESS BUILD'1,1G . E ADDRESS LOCALITY NEAREST CITY ZIP CROSS ST. NO, OF BLDGS, ASSESSOR SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL DISTRICT GROUP TYPE FIRE PROCESSED BY TRA�*,:51162 I BLOCK LOT NO. CONST. ZONE TEL OWNER O STATISTICAL CLASSIFICATION SEWER MAP ADDRESS • CLASS NO. DWELL. UNITS BK PG ZIP USE ZONE MAP CITY NO. ARCHITECT OR I I EL. SPECIAL ENGINEER NO. CONDITIONS ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑ TEL. CONTRACTOR NO. BLDG. SETBACK FROM (STREET) LIC. FRONT PROP, LINE OF ADDRESS NO. TOTAL SETBACK FROM TYPE OF EXISTING HIGHWAY + YARD = FRONT PROP. LINE HIGHWAY WIDTH LIC. CITY CLASS CONSTRUCTION LENDER NAME AND BRANCH BLDG. SETBACK FROM SIDE PROP. LINE OF (STREET) ADDRESS CITY TOTAL SETBACK FROM TYPE OF EXISTING SQ. FT. NO. OF NO, OF CHECK HIGHWAY + YARD = SIDE PROP. LINE HIGHWAY WIDTH SIZE STORIES FAMILIES ONE ❑ + DESCRIPTION OF WORK NEW ADD ❑ CORNER CUTOFF YES ❑ NO ❑ ALTER ❑ IN OPEN SPACE YES ❑ / NO ❑ ❑ REPAIR IN COASTAL ZONE YES Q NO ❑ USE OF ❑ EXISTING BLDG. DEMOL PERMIT APPLICANT TEL 1 (PRINT) NO. t BY (SIGNATURE)✓ AND STATE J, • HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THATTHE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES ,r , 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- PENSATIONINSURANCE.`% SIGNATURE OF FINAL BY PERMITTEE DATE ADDRESS TEL, P.C. Fee $ Permit Fee CITY NO. Issuance Fee VALUATION ®®� Total Fee ..wil ON e. 1161 14LIFIr.111111111 Lej', 37.55 6 1 373 23 CK. M.O. CASH 9.6 0 t r CKmll VMLILfM11W1V GK. M.V. .+F ©5 76A63813CE g803B 6/76