HomeMy WebLinkAbout6849 (15)APPLICATION 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.
SIZE OF LOT'(; NOW ON LOT �'
BUILDING
ADDRESS
TRACj2)jb
BLOCK
LOT NO.
LOCALITY
a, y, r TEL
' OWNER f NO. r
NEAREST
CROSSST.
ply y
ADDRESS •,��)" E
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ASSESSOR
MAP BOOK
PAGE
PARCEL
'I
DISTRICT GROUP CONST. ZONE TYPE FIRE
PROCESSED BY
ZIPS'
117
i
ARCHITECT OR j EL.
`� NO. ` �
V
to s
ENGINEER `Q e7
STATISTICAL CLASSIFICATION
SEWER MAP
ADDRESS � .l 1
CLASS NO. 0 DWELL, UNITS
BK PG
TEL. n ti
CONTRACTOR NO.
MA
USE ZONE MAP
p LIC.
ADDRESS) '°d�NO.
SPECIAL
LIC T
CONDITIONS
P CITY �' CLASSY
ROAD DEPARTMENT APPROVAL REQUIRED
YES ❑ NO ❑
CONSTRUCTTON EENDER
NAME AND BRANCH i k )
BLDG. SETBACK FROM
A,
FRONT PROP. LINE OF
(STREET)
ADDRESS CITY
TOTAL SETBACK FROM
HIGHWAY + YARD =
TYPE OF EXISTING
SQ. FT. NO. OF r"¢ NO. OF CHECK
FRONT PROP, LINE
HIGHWAY WIDTH
SIZE STORIES r FAMILIES ONE
DESCRI Ti ORK ( ° ( eb r NEW
+ _
ykV ,I c ADD ❑
y fj `_ '. it Al2kM
BLDG. SETBACK FROM
SIDE PROP. LINE OF
(STREET)
ALTER ❑
TOTAL SETBACK FROM
TYPE OF EXISTING
,- _ ❑
HIGHWAY + YARD = SIDE PROP. LINE
HIGHWAY WIDTH
' USE OF REPAIR
EXISTING BLDG. DEMOL El+
APPLICANT TEL114 9 .--=
CORNER CUTOFF YES ❑
NO ❑
(PRINT( - NO. q
IN OPEN SPACE Y S ❑
NO ❑
BY (SIGNATURE(
IN COASTAL PERMIT ZONE
NO
VALUATION
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
,d
�. 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.
IGO
SIGNATURE OF
PERMITTEE J6.
R VA a
`�B
BY
' f J TEL. (�liKg�
J
DATEL
CITY I� l 6�; NO.
FEE' $ F ET
MAKE CHECKS PAYABLE TO:
HARVEY T. BRANDT, COUNTY ENGINEER______j
4 �a�/o i `
CK. M.O. CASH
0
PERMIT VALIDATION CK. M.O. CASH
®s' 76A638A CE t1813 3-75