HomeMy Public PortalAbout5417TEMPLE CITY BLVD_Building APPLICATION FOR BUILDING PERMIT,. _4fo �I
FOR APPLICANT TO FILL IN (P, DI o, IYP• GDIY) 78-891 RIS IJ
BUILDING 111 Tem le Cit Blvd COUNTY OF LOS ANGELES
ADDREss DEPARTMENT OF COUNTY ENGINEER
CITY Temple Cit - ZIP BUILDING AND SAFETY DIVISION
NO OF SLOGS BUILDING
SIZE OF LOT NOW ON LOT ADDRESS
TRACT BLOCK - LOT NO 1. LOCALITY ,�...//, '
NEAREST
OWNER CBarbara Daniels NE�8 -41 CROSS ST C��✓�
SSOR
ADDRESS 5 `17 Temple City BlVd MAPBOOK - PAGE- PARCEL
DISTRICT GROUP TYPE FIRE PROCESSED BY
CITY Templet City ZIP r ' �L, CONST._ ZONE �,(//w/
ARCHITECT OR TEL S-� T /�S _//
ENGINEER NO
STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS CLASS NO DWELL UNITS BK Z, PG
CONTRACTOR Rigid MP • Co. TEL 26 - 181 U E ONE MAP rJ
o^ `` V NO 20 C �
ADDRESS P O•BOx 682 No
Z CONDII TIONS
CITY LOB Angeles C ASS LICC-39 _
ROAD OE PARTMENT APPROVAL REQUIRED YES❑ NO ❑
CONS AUCB N LENDER
NAME AND BRANCH BLDG SETBACK FROM
FRONT PROP LINE OF ISTREETI
ADDRESS CITY _ TOTAL SETBACK FROM TYPE OF EXISTING
HIGHWAY } YARD -
SI FT ST OF NO OF CHECK FRONT PROP LINE HIGHWAY wIpTH FFCCtlF--11��
SIZE STORIES FAMILIES ONE
DESCRIPTION OF WORK
IRE
W ❑Ri 1d 01800 „CnviD ❑ SIDEPROP LNEOF_UG SETBACK OM ISTREETI
meterieel TER ❑ HIGHWAY } yApp - TOTAL SETBACK FROM TYPE OF EXISTING
PAIR SIDEPROP LINE HIGHWAY WIDTH
P C:
USE OF _ }EXISTING BLDG Residence MOL ❑APPLICANT TELCORNER CUTOFF YES ❑ NO(PRINT) NO
BY (SIGNATURE) IN OPEN SPACE YES ❑ NOIN COASTAL ZONE , YES ❑ NOVALUATIONY CATEGORICAL EXEMPTION YES❑ NO ❑1 NER ACR WLEGE THAT I HAVE READ TICATIOM EHYIRONM ENTAL
1MD THAT E AIOVC I! CORRECT AMD ACOMPLY IMPACT fXfMPTION pECLARATION lIGNEp (pATEI
WITALL ORDI MI CC! AND LAW! REOULATIMO HO CON-
ST CTION t C[ IITTHAT IN DOING THE WHORI2Ep IMPACT REPORT PROCESSEp (DATE)
HE E!TL T EMPLAMT PERION 1 VIOI TNfLA OR CODE OF THE !TATE OFCALII 1 TING TO✓�L 9ENH LEP�SaYlSIG TUREPERMADD S Woods Ave
FINALQB /� �!ITY TOOPTE 4 � OV KL/92Z-
MAKF CHECKS PAYABLE TFEE JM FEE
HARVEY T BRANDT COUNTY EER `/� W D�
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`PLAN CHECK VALIDATION _ CK MO CASH PERMIT VALIDATION CK M 0 CASH
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7GA638A CEN803 7/73 0 61111 • N
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