HomeMy WebLinkAbout6867 (15)APPLICATION 1 1 1
FOR APPLICANT TO FILL IN (Print or type only)
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BUILDING
DEPARTMENT OF COUNTY ENGINEER
ADDRESS
BUILDING AND SAFETY DIVISION
CITY
ZIP
NO. OF BLDGS.
BUILDING
SIZE OF LOT
NOW ON LOT
ADDRESS
TRACT _}
BLOCK
LOT NO.
LOCALITY `
TEL.
NEAREST
OWNER
'� NO.
CROSS ST.ASSESSOR
ASSESSOR
ADDRESS
MAP BOOK
PAGE
PARCEL
DISTRICT GROUP TYPE FIRE
PROCESSED BY
-CITY
ZIP
_ CONST. ZONE
ARCHITECT OR
TEL.
ENGINEER
NO.
STATISTICAL CLASSIFICATION
SEWER MAP
ADDRESS
CLASS NO. 6 1 DWELL. UNITS A (
BK PG
TEL.
CONTRACTOR
NO.
USE ZONE MAP
LIC.
NO.
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
HIGHWAY + YARD TOTAL SETBACK FROM
-
TYPE OF EXISTING
SQ. FT. .- NO. OF
NO. OF CHECK
FRONT PROP. LINE
HIGHWAY WIDTH
f ,,
SIZE C r1 t5 STORIES
FAMILIES ONE
DESCRIPTION OF WORK
NEW
+
L I f
fl!
fl ADD ❑
P
BLDG. SETBACK FROM
SIDE ROP, LINE OF
STREET)
l
ALTER ❑
TOTAL SETBACK FROM
I TYPE OF I EXISTING
❑
HIGHWAY + YARD = SIDE PROP. LINE
AYI WIDTH
USE OF
EXISTING BLDG.
REPAIR
DEMOL ❑
+ _
APPLICANT
TEL
CORNER CUTOFF YES ®
NO ❑
(PRINT)
N.O.
IN OPEN SPACE YES
NO ❑
BY )SIGNATURE) sad'
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
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.
ul
SIGNATURE OF
PERMITTEE
ADDRESS
FINAL BY
TEL.
DATE
CITY
NO.
FEE' FEET
=MAKE CHECKS PAYABLE
TO:
HARVEYT. BRANDT, COUNTY ENGINEER
CK. M.O. CASH
PERMIT VALIDATION CK. M.O. CASH
®5 76A63BA CE N803 3-75