HomeMy WebLinkAbout6855APPLICATION I IPERMIT !!
FOR APPLICANT TO FILL IN (Print or type only)
BUILDING
DEPARTMENT OF COUNTY ENGINEER
ADDRESS
BUILDING AND SAFETY DIVISION
CITY ZIP
NO. OF BLDGS.
BUILDING
r SIZE OF LOT NOW ON LOT
ADDRESS
(�
TRACT
BLOCK
LOT NO.
LOCALITY
TEL.
NEAREST
OWNER NO.
CROSS ST.
Iw
ASSESSOR
ADDRESS
MAP BOOK
PAGE
PARCEL
DISTRICT GROUP TYPE FIRE
PROCESSED BY
ZIP
CONST. ZONE
-CITY
ARCHITECT OR TEL.
-. ENGINEER NO
r.
STATISTICAL CLASSIFICATION
SEWER MAP
ADDRESS
CLASS NO. 06 DWELL. UNITS
BK PG
TEL.
CONTRACTOR NO.
USE ZONE MAP
NO.
LIC.
r ADDRESS NO.
SPECIAL
CONDITIONS
LIC
'- CITY CLASS
ROAD DEPARTMENT APPROVAL REQUIRED
YES ❑ NO ❑
CONSTRUCTION LENDER
NAME AND BRANCH
BLDG. SETBACK FROM
(STREET)
FRONT PROP. LINE OF
' ADDRESS CITY
HIGHWAY F YARD TOTAL SETBACK FROM
TYPE OF EXISTING
SQ. FT � NO. OF NO. OF CHECK
FRONT PROP. LINE
HIGHWAY WIDTH
�,
SIZE STORIES d r" FAMILIES ON
DESCRIPTION OF WORK NEW
+
ADD
BLDG. SETBACK FROM
(STREET)
SIDE PROP, LINE OF
r _ ALTER ❑
TOTAL SETBACK FROM
TYPE OF EXISTING
_
=
HIGHWAY + YARD SIDE PROP. LINE
HIGHWAY WIDTH
REPAIR ❑
USE OF
EXISTING BLDG. DEMOL ❑
+ —
APPLICANT �h.� TEL
CORNER CUTOFF YES ®
NO ❑
(PRINT) NO.
IN OPEN SPACE YES ❑
NO ❑
BY (SIGNATURE)
IN COASTAL PERMIT ZONE YES ®
NO
„
VALUATION
f
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
PERMITTEE
T L.
FINAL
DATE
BY
' CITY NO.
P.C.
PMT.
MAKE CHECKS PAYABLE TO:
FEE
FEE
FIARVEYT. BRANDT, COUNTY ENGINEER
CK. M.O. CASH
PERMII VALIUAII11UN CK. M.O. CASH
®s 76A638A CE #803 3-75