HomeMy Public PortalAbout4818 AGNES AVE_Building_8/2/1978_close in patio, alter existing rm — �
FPP L I C AT I O N F O RR
BUILDING PERMIT
BUILDING
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FOR APPLICANT TO FILL IN ADDRESS
BUILDING
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ADDRESS C N LOCALITY
rt CITY—zj �(� yy� zip P I ASSESSOR/7 f t CROOSS sT U
SIZE OF LOT 400 X S0 NOW ON LOT ! MAP BOOK PAGE r PARCEL
DISTGROUP TYPE FIRE PROCESSED
TRACT - BLOCK LOT NO CONST ZQUE 4e1
OWNER 6vF�/'` NO.
O CJly
STATISTICAL CLASSIFICATION + SEWER MAP
ADDRESS , CLASS NO DWELL UNITS BK G
CITY G ZIP USE ZONE MAP
ARCHITECT OR ! '4 TEL 7 7 NO
SPECIAL
ENGINEER �,f��C ti; ` R� NO A �/
{���� A CONDITIONS
1 ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED I YES❑ No -
TEL
CONTRACTOR { '� �� "a'NO BLDG SETBACK FROM d /+ ,���
LIC FRONT PROP LINE OF A o6 A&`I:;: ISTREETI
ADDRESS NO _ TOTAL SETBACK FROM TYPE OF EXISTING
LIC HIGHWAY + YARD 4 , FRONT PROP LINE HIGHWAY WIDTH
CITY - - CLASS _
CONSTRUCTION LENDER OWAI f + /-&; a
NAME AND BRANCH_ (7(�V� I BLDG SETBAC FROM U
SIDE PROP LIN F ISTREETI
ADDRESS CITY O
SQ FT NO OF NO OF CHECK HIGHWAY + YA TOTAL CK FROM TYPE OF EXISTING
SIZE STORIES FAMILIES ONE SI P LINE HIGHWAY WIDTH a
N
DESCRIPTION OF WORK �Af NEW
K ADD L CORNER CUT NO ❑
ALTER IN OPEN SPACE YES ❑ NO
REPAIR ❑
USE OF IN COASTAL PERMIT ZONE YES ❑ NO
EXISTING BLDG a 10 DEMOL ❑
APPLICANT //TEL L r T t
(PRINT) L l� �
BY(SIGNATURE)
% +
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICA ION 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
T
SIGNATURE OF FINAL
PERMITTEE DATE l/
ADDRESS � _
- T PC Fee$ Permit Fee
CITY
Issuance Fee
VALUATION$ ���'
Total Fee J15-0
PLAN CHECK VALIDATION CK M o CASH PERMIT VALIDATION CK mo CASH
304OL 1 0 1 0 355 ®y�
•w F
4 �
f 1
®S 7GA6388 CE 11180313 6/76 / f/ d
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