HomeMy Public PortalAbout5803AGNES AVE_Building (3) APPLICAWOFOR, �� � C-4- -
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BUILDING PERMITF POLICYHOLDER
FOR APPLICANT TO FILL IN
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CITY 1 l r � �t ZIP CROSS ST
NO OF BLDGS ASSESSOR
SIZE OF LOT CO JXV NOW ON LOT MAP BOOK PAGE PARCEL
DISTRICT GROUP I TYPE FIRE ESSED BY
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OWNER NO d �^
STATISTICAL CLASSIFICATION SEWER AA<
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ADDRESS G V '�S CLASS NO DWELL UNITS r BK `
CITY ZIP USE ZONEMAP
ARCHITECT OR - TEL NO x
ENGINEER ,�/ SPECIAL
CONDITIONS
A ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑
TEL [[��,,,,
CONTRACTOR D NO ^?fib BLDG SETBACK FROM
A iLIC ��/ (J FRONT PR LINE OF (STREET)
ADDRESS S" _S./rT/� �I NO 1--)^I ✓ / / TOTAL SETBACK FROM r TYPE OF EXISTING
(� �f HIGHWA + YARD = FRONT PROP LINE HIGHWAY WIDTH
CITY 1 1'^1 U 1- I� CLASS
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CONSTRUCTION LENDER
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NAME AND BRANCH BLDG SE ACK FROM
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SIDE PROP INE OF (STREET) �
ADDRESS CITY 0
SQ FT NO OF NO OF / CHECK HIGHWAY + YARD - TOTAL SETBACK FROM TYPE OF EXISTING U
SIZE 1ZL^i STORIES FAMILIES ONE SIDE PROP LINE HIGHWAY WIDTH wa
❑ + Z
DESCRIPTION OF WORK NEW
ADD CORNER CUTOFF YES ❑ NO ❑
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a ST,4 l Q v ALTER IN OPEN SPACE YES ❑ NO
C r 1 / REPAIR ❑ _
EUSE X STOING BLDG S'f,tK `-FAQ Duu l! (� EMOL ❑ I`COASTAL PERMIT ZONE YES ❑ NO ❑
APPLICANT L
(PRINT) OS ZAA. AD � NO
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BY(SIG C
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE �/TlJu 2-
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES �J
AND LAWS REGULATING BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THEyZO/7� J�r�,f-3d.11�I �.�/L �N�� �L.►�L
WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF / 1
THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN S COM
PENSATION INSURANCE
SIGNATURE OF FINAL '/ _ � B
PERMITTEE DATE JJ
ADDRESS,�]Z
CITY �" , -- - NO TEL PC Fee$ / Q Permit Fee �p ^
VALUATION.Q Issuance Fee
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tal Fee ) (mss - V
PLAN CHECK VALIDATION cK M o CASH _ PERMIT VALID i N cK` mo CASH
1 9 0 OGT 3 3 8 1 9 0 0`
yam' , 0 0 7 Dov 1 0 1 3 6 5 0 �►`�
flll-10-638B CE X803B 6/76 6?
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