HomeMy WebLinkAbout6860APPLICATION 1 1PERMIT
FOR APPLICANT TO FILL IN (Print or type only) ®®
BUILDING
DEPARTMENT OF COUNTY ENGINEER
ADDRESS
BUILDING AND SAFETY DIVISION
ary ZIP
NO. OF BLDGS.
BUILDING
r SIZE OF LOT NOW ON LOT
ADDRESS
TRACT 6
BLOCK
LOT NO.
LOCALITY
TEL.
NEAREST
OWNER NO,
CROSS ST.
ASSESSOR
ADDRESS
MAP BOOK
PAGE
PARCEL
DISTRICT GROUP TYPE FIRE
PROCESSED BY
-CITY ZIP
s . CONST. ZONE
r1
ARCHITECT OR TEL.
T
ENGINEER NO.
STATISTICAL CLASSIFICATION
SEWER MAP
a ADDRESS
CLASS NO.. —DWELL. UNITS
BK PG
TEL.
CONTRACTOR NO.
USE ZONE MAP
NO.
LIC.
* 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 t 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 -
ISTREET)
p B ALTER ❑
TOTAL SETBACK FROM
HIGHWAY H YARD =
TYPE OF EXISTING
❑
SIDE PROP. LINE
HIGHWAY WIDTH .
USE OF REPAIR
EXISTING BLDG. DEMOL ❑
+
_
APPLICANT` Y 4' TEL
s,
CORNER CUTOFF YES ®
NO ❑
(PRINT) NO. ��! =
(f j 0-t 1
IN OPEN SPACE YES ❑
NO ❑
BY (SIGNATURE) l�"�
IN COASTAL PERMIT ZONE YE ®
NO ❑
VALUATION j���
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 INSURAN(�
SIGNATURE OF �'U`
PERMITTEE
ADDRESS
FINAL BY
TEL.
DATE
CITY NO.
P.C.E$ FEET
=EN�GIN=EER
WARV�gi"
=BRANDT,
CK. M.O. CASH
PERMIT VALIDATION CK. M.O. CASH
Os 76A638A CE #803 3.75