HomeMy WebLinkAboutN/A (1369)I APPLICATION FOR BUILDING PERMIT a
FOR APPLICANT TO FILL IN (Print or type only) rru IfjTv _s_9TT_T%__A__aF._PrPq_
BUILDING
DEPARTMENT OF COUNTY ENGINEER
' ADDRESS
BUILDING AND SAFETY DIVISION
rr CITY ZIP
' NO. OF BLDGS.
SIZE OF LOT % NOW ON LOT
BUILDING
ADDRESS
TRACT BLOCK
LOT NO.
LOCALITY
' TEL.
OWNE11))?,� (�`''r NO.p�a� (1,-16/
NEAREST
CROSS ST.
7� y r
ADDRESS6 //,,' ` �% " G f L i%YL
ASSESSOR
MAP BOOK
PAGE
PARCEL
DISTRICT GROUP TYPE FIRE
PROCESSED BY
„ -CITY �ii i ZIP ILI) o(!(''f
ZONE
ARCHITECT OR 1 TEL �,
ENGINEER l f.6 ¢' G ` NQ � ' 6 _ V
STATISTICAL CLASSIFICATION
SEWER MAP
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ADDRESS �Jr;; 9 "1rr r_�,-1't1 °"ruz--
CLASS NO. DWELL. UNITS 77
BK PG
w TEL. "
CONTRACTOR/ 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
(STREET)
FRONT PROP. LINE OF
s. ADDRESS CITY
HIGHWAY + YARD _ TOTAL SETBACK FROM
TYPE OF EXISTING
SQ. FL NO. OF NO. OF CHECK
FRONT PROP, LINE
HIGHWAY WIDTH
'w SIZE 00A STORIES FAMILIES ONE
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
USE OF
EXISTING BLDG. DEMOL ❑
+ _
r APPLICANT TEL
CORNER CUTOFF YES ❑
NO ❑
(PRINT) NO.
IN OPEN SPACE YES ❑
NO ❑
BY )SIGNATURE)
IN COASTAL PERMIT ZONE ES ❑
NO
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VALUATION° > 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 OF
1-9
PERMITTEE
ADDRESS
'HWAL
BY
TEL.
DATE
CITY NO.
P.C.
PMT. G
MAKE CHECKS PAYABLE TO:
FEE
FEE V
WARVEYT. BRANDT, COUNTY ENGINEER
/ /—e<} J4 ")
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
®5 76A63BA CE #803 3-75'