HomeMy WebLinkAboutN/A (1368)APPLICATION [ 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 E NOW ON LOT
BUILDING
ADDRESS
TRACT
BLOCK
LOT NO.
LOCALITY
TEL.
OWNERJ.'), ) I - h' `' jf` d NO.,,
NEAREST
CROSS ST.
{ y�
ADDRESS
ASSESSOR
MAP BOOK
PAGE
PARCEL
-CITY '- tf ZIP t [ , lf'
DISTRICT GROUP TYPE FIRE
CONST. ZONE
PROCESSED BY
ARCHITECT OR TEL
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ENGINEER4.C„xs. NOrif
STATISTICAL CLASSIFICATION
SEWER MAP
� ��4 2 � '�
ADDRESS �y � _- � � "�
CLASS NO. DWELL. UNITS
BK PG
j TEL.
CONTRACTOR "+ f� f' NO.
USE ZONE MAP
LIC. /
ADDRESS NO.
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 + YARD =
TYPE OF EXISTING
SQ. FL i NO. OF NO. OF CHECK
�STORIES
FRONT PROP. LINE
HIGHWAY WIDTH
' SIZE FAMILIES ONE
DESCRIPTION OF WORK `�' � a NEW
_
+
! Y
ADD ❑
BLDG. SETBACK FROM
(STREET)
SIDE PROP. LINE OF
ALTER ❑
TOTAL SETBACK FROM
TYPE OF EXISTING
❑
HIGHWAY + YARD = SIDE PROP. LINE
HIGHWAY WIDTH
REPAIR
' USE OF
EXISTING BLDG. DEMOL ❑
+ _
APPLICANT TEL
CORNER CUTOFF YES ®
NO ❑
(PRINT) NO.
❑
NO ❑
IN OPEN SPACE YES
BY (SIGNATURE(
IN COASTAL PERMIT ZONE ES ®
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,
SIGNATURE OFt
PERMITTEE
ADDRESS
FINAL
BY
TEL.
DATE
CITY NO.
P C
MAKE CHECKS PAYABLE TO:
FEE
FEE
FEE
HARVEY T. BRANDT, COUNTY ENGINEER
CK. M.O. CASH
PERMIT VALIL)AIIUN CK. M.O. CASH
(bS 76A638A CE #803 3-75