HomeMy Public PortalAbout5235TEMPLE CITY BLVD_Building APPLICATION FOR BUILDING PERMIT
FOR APPLICANT TO FILL IN (Print or 1TBB only)
tB UI LOING ILDING /+ 'LLLJII
ADDRESS r DRESS
No
CITY ZIP ,
N OF BLDG5 LOCALITY -
SIZE OF T 3I NOW ON LOT NEAREST
CROSS ST
,�((��JJ ,Q ASSESSOR
YRAC� BLOCK LOT NO MAP BOOK - - - - PAGE - PARCEL---
DISTRICT GROUP DISTRICT GROUP TYPE FIRE P OCESSED BY
OWNER O —SSI CONST ZONE
ADDRESS Q
�/� O� STATISTICAL CLASSIFICATION SEWER MAP
CITY ZIP a CLASS NO DWELL UNITS BK PG
ARCHI ECT OR y�/A.,.,�/� TEL
ENGINEER 4 i^' ���A/ NO USE ZONE MAAP
No
ADDRESS - �./ SPECIAL
EL CONDITIONS
PING
ACTOR
LIC ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑
SS NO
BLDG SETBACK FROM
LIC FRONT PROP LI NE OF -(STREET)
CLASS
RUCTION LENDER HIGHWAY + YARD p TOTAL SETBACK FROM TYPE OF EXISTING
FRONT
PROP LINE HIGHWAY WIDTH
ND BRANCH -
SS CITY +
NO OF / NO OF CHECK BLDG SETBACK FROM U
STORIES / FAMILIES ONE SIDE PROP LINE OF ISTREETI
NEW HIGHWAY + YARD TOTAL SETBACK FROM TYPEO F EXISTING O
IPTION OF IpRK _ ❑ SIDE PROP LINE HIGHWAY WIDTH U
DD ❑ _
+ - o
ALTER ❑ Z_
PAIR❑ CORNER CUTOFF YES ❑ NONG BLDG EMOL IN OPEN SPACE YES NOCAN t L 1' -'� IN COASTAL ZONE YES ❑ NO ❑
P RI NT) Ov
BY (SIGNATURCATEGORICAL EXEMPTION YES❑ NO ❑
fiNYIRONMENTAL
O IMPACT EXEMPTION DECLARATION SIGNED (DATE)
VALUATION O IMPACT REPORT PROCESSED (PATE)
I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IB CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES-AMD LAWS REGULATING BOILDI NG CON
STRUCTIOM I CERTIFY THAT IN DOING THE WORK AUTHORIiED
HERESY WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
LA DOA CODE 01 THE STATE OI CALIFORNIA IN RELATING TO
WORKMEN S COMPENSATION INSURANCE
SIGNATURE OF FINAL / BY
PERMITTEE DATE Al 30� 73
ADDRESS C t PMT $
j EE $ FEE Y
CIT
PLAN CHECK VMMATION CK M 0 CASH PERMIT VALIDATION cX .0 CASH
3 9 6�J'mR .>1 .1 U 1 G.0 0 AJO
78AB388 CENS03A 5/73