HomeMy Public PortalAbout5325 ZADELL AVE_Building_5/22/1975_ APPLICA ON FO ' UILDING PERMIT '
FOR APPLICANT TO FILL IN (Print or type onlY)
BUILADDRESI NGS-5 �14 d-flL u
BUILDING
Rf
ADDr?ESS � d � '✓�� ,
CITYZIP 17 LOCALITY s
1 . NO.OF BLDGS.
SIZE OF LOT XCROSS S
�J� NOW ON LOT NEARESTST.
ASSESSOR
TRACT BLOCK LOT NO. MAP�BOOK PAGEPARCEL
TEL. DISTRICT GR UP TYPE FIRE PRO ESSED BY
OWNER C. NO. ON ZONE
ADDRESS
y h STAITISTICAL CLASSIFICATION SEWER MAP
CITY ZIP / v I -2��
ARCHITECT OR TEL. CLASS NO.�" `� DWELL,UNITS BK FG
ENGINEER NO. USE'ZONE MAP
NO.
ADDRESS m^ Q� SPECIAL
TEL CONDITIONS
CONTRACTOR S' QL�f NO
LIC. ROpID DEPARTMENT A.PFROV.AL REQUIRED YES❑ NO❑
ADDRESS NO. 13LDG.SETBACK FROM '
CITY LIC. FRONT PROP.LINE OF (STREET)
CLASS - TOTAL SETBACK FROM TYPE OF EXISTING
CONSTRUCTION LENDER HIGHWAY + YARD — HIGHWAY WIDTH
FRONT PROP. LINE
NAME AND BRANCH .-
ADDRESS CITY +
SQ. FT. NO. OF NO. OF CHECK BLDG.SETBACK FROM O
SIZE STORIES FAMILIES ONE SIDE PROP.LINE OF (STREET) v
NEW ® HIGHWAY + YARD TOTAL SETBACK FROM TYPE OF EXISTING Cd
DESCRIPTION OF WORK J ADD SIDE PROP. LINE HIGHWAY WIDTH C3
O / • ❑ t = d
�• $ S-�/.� ALTER ❑ CORNER CUTOFF YES ❑ NO ❑ y
eJ J z
REPAIR[:]
USE OF
EXISTING BLDG. DEMOL ❑ IN OPEN SPACE YES.❑ NO ❑
APPLICANT TEL IN,COASTAL,ZONE YES ❑ NO ❑
(PRINT) NO.
BY (SIGNATURE) ENVIRONMENTAL CATEGORICAL EXEMPTION YES❑ NO ❑
IMPACT EXEMPTION DECLARATION SIGNED (DATE)
4 O d�
VALUATION�Y IMPACT REPORT PROCESSED (DATE)
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO XOMPLY t,
WITH ALLORDINANCES AND LAWS REGULATING BUILDING CON-
STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED
HEREBY COWILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
LABOR CDE OF THE ST CA IF RNIA IN RELATING TO
WORKMEN'S COMP TI I IN RA! .�fj9 '
SIGNATURE OF FINAL BY
PERMITTEE. DATE r Y
ADDRESS 3 A' P FEE FEE
TEL.
CITY 7� NO..
1
PLAN CHECK VALIDATION CK. M.O. CASH IT VALIDATION clic M.O. CASH
5 1 4 PF 1 D 2 1.7 5 ®gin
76AG38B CE#803A 5/73