HomeMy WebLinkAbout6859/-VPPLICATION FOR BUILDINGPERMIT
FOR APPLICANT TO FILL IN (Print or type only) r, —
DEPARTMENT OF COUNTY ENGINEER
FADDR7ESS
I3UILDING AND SAFETY DIVISION
ZIP
NO. OF BLDGS.
BUILDING
SIZE OF LOT NOW ON LOT
ADDRESS
TRACT
BLOCK
LOT NO,
LOCALITY bQA
TEL.
NEAREST
OWNER NO.
CROSS ST.
ASSESSOR
ADDRESS
MAP BOOK
PAGE
PARCEL
DISTRICT GROUP TYPE FIRE
PROCESSED BY
-CITY ZIP
y CONST. ZONE
�l
ARCHITECT OR TEL.
ENGINEER NO.
STATISTICAL CLASSIFICATION
SEWER MAP
ADDRESS
CLASS NO. In DWELL. UNITS ` "
BK PG
TEL.
CONTRACTOR NO.
USE ZONE MAP
LIC.
NO.
ADDRESS NO.
SPECIAL
CONDITIONS
LIC.
CITY CLASS
ROAD DEPARTMENT APPROVAL REQUIRED
YES ❑ NO ❑
v CONSTRUCTION LENDER
NAME AND BRANCH
BLDG. SETBACK FROM
FRONT PROP. LINE OF
(STREET)
ADDRESS CITY
TOTAL SETBACK FROM
TYPE OF EXISTING
SQ. FT. NO. OF NO. OF CHECK
HIGHWAY + YARD = FRONT PROP. LINE
HIGHWAY WIDTH
SIZE STORIES FAMILIES ON
DESCRIPTION OF WORK NEW
+
ADD ❑
BLDG. SETBACK FROM
(STREET)
SIDE PROP. LINE OF
/ ALTER ❑
TOTAL SETBACK FROM
TYPE OF EXISTING
❑
HIGHWAY + YARD _ SIDE PROP. LINE
HIGHWAY WIDTH
REPAIR
G. DEMOL ❑
+ _
a TEL
r(SIGNATURE)
CORNER CUTbFF YES
NO
- NO.IN
OPEN SPACE YES
NO
��
- ,IN
COASTAL PERMIT ZONE YES ®
NO
r t C.(
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 O I
PERMITTEE�'
ADDRESS
FINAL
BY
TEL. (
DATE
CITY NO.
FEE'
CHECKS PAYABLE TO:
F ET
=MAKE
HARVEYT. BRANDT, COUNTY ENGINEER
C rJ
CK. M.O. CASH
2'� 0,20 T
PERMIT VALIDATION CK. M.O. CASH
®s 76A638A CE #803 3-75