HomeMy Public PortalAbout5806AGNES AVE_Building APPLICATION FOR BUILDING PERMIT
FOR APPLICANT TO FILL IN (Print or type only) I TEMPLE CITY
BUILD NG CO ELES
ADDRESS SR06IH0
AqnpS St Tinmn1p C 1 ty DEPARTMENT OF COUNTY ENGINEER
clry ZIP 91 BUILDING 17 AND SAFETY DIVISION
NO OF BLDdS7 BUILDING //��
SIZE OF LOT Q NOW ON LOT ADDRESS V JAA --e.
TRACT ^ / BLOCK LOT NO �iC.J LOCALITY
TEL NEAREST
OWNER Stella. Mjjnarpvir�o CROSS ST
ASSESSOR
ADDRESS 5806 No Agnes St MAP BOOK PAGE PARCEL
DISTRICTGROUP TYPE FIRE CESSED BY
CITYTemple CityZlp ¢ , CONST Z ,
ARCHITECT OR TEL
ENGINEER NO
STATISTICAL CLASSIFICATION SEWER AP
ADDRESS CLASS N04=2 /JDWELL UNITS E— BKPG
CONTRACTORRanrCC)TEL _ USE ZONE MAP /
LIC NO
ADDRESS29 E . Val lev NO SPECIAL
LIC CONDITIONS
CITYSan Gabriel ,Cal . CLASS - ROAD DEPARTMENT APPROVAL REQUIRED YES NO ❑
CONSTRUCTION LENDER
NAME AND BRANCH BLDG SE BACK FROM 4.
FRONT P OP LINE OF (STREET) C
C
ADDRESS CITY HIGHWAY + YARD -_ TOTAL SETBACK FROM TYPE OF EXISTING C
SQ FT NO OF NO OF CHECK FRONT PROP LI44E HIGHWAY WIDTH H
SIZE STORIES FAMILIES ONE L
- LL
DESCRIPTION OF WORK NEW a
❑ CL
ADD BLDG SETBA OM (STREET)
Re-roof Dw1g & Gar t SIDEPROP LINED
ALTER ❑ HIGHWAY + YARD TOTAL SETBACK FROM PE OF EXISTING
12x18 Compo . S4, =
REPAIR SIDE PROP LINE HI WAY WIDTH
USE OF t =
EXISTING BLDG DEMOL ❑ I
APPLICANTTEL CORNER CUTOFF YES ❑ NO ❑
(PRINT) H L Ran o CoNO 288-404
BY (SIGNATU ) IN OPEN SPACE YES ❑ NO ❑
(� IN COASTAL ZONE YES ❑ NO ❑
�ALUATION $1585 QO CATEGORICAL EXEMPTION YES❑ NO ❑
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE)
WITHALL ORDINANCES AND LAWS REGULATING BUILDING CON
ST RUC TION I CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE)
HEREBY I WILL NOT EM LO ANY PERS IN VIOLATION OF THE !
LABOR CODE OF THE E O C IF RNIA N RELATING TO
WORKMEN S COMPEN INS N E
SIGNA-URE
PERMITTEE
ADDRESS
FINAL
BY
TEL DATE /v � 9 i 7�1>> ®yr 2f PI c
CITY NO
MAKF CHECKS PAYABLl TO FEE $ , FEE $ `Z1 75FHARVEYT BRANDT COUNTY ENGINEER
PLAN CHECK VALIDATION CK M O CASH PERMIT VALIDATION LI)
M 0 CASH
02zo 1 ' 2175896
76A638A CE#803 7/73 M /
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